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Chronic recurrent multifocal osteomyelitis (CRMO), an autoinflammatory bone disorder characterized by non-bacterial osteomyelitis causing recurrent multifocal bone lesions, is a well-known, yet uncommon pediatric condition that rarely affects adults; to date, it has never been diagnosed over the age of 75. The following report will discuss the first octogenarian diagnosed with CRMO and therefore represents an exceptionally rare presentation of a rare disease. An 83-year-old woman presented with progressive right shoulder, forearm, and hip pain, with associated weight loss and global weakness, requiring a wheelchair for mobility. Imaging revealed a pathologic right ulna fracture in addition to lytic lesions of the right proximal humerus and proximal femur. The clinical picture was thus that of a patient with probable multiple myeloma versus metastatic disease. After an extensive workup, however, the lesions were not malignant; histologic findings were instead suggestive of chronic osteomyelitis with negative cultures. Given the multifocal nature of this condition, combined with a lack of clinical symptoms of infection, a diagnosis of CRMO was rendered. The patient underwent intramedullary nailing of the right femur and splinting of the ulna, with a subsequent remarkable recovery to painless ambulation, complete union of the right ulna fracture, and resolution of the lytic lesions without receiving any targeted medical treatment. This case highlights the importance of maintaining CRMO on the differential for multifocal skeletal lesions, regardless of age. Performing a thorough workup with necessary imaging, biopsy, and culture are critical to establishing this diagnosis, which can only made as a diagnosis of exclusion. [ABSTRACT FROM AUTHOR]

Rationale: Because of the effects of aging on the respiratory system, it is conceivable that the association between driving pressure and mortality depends on age. Objectives: We endeavored to evaluate whether the association between driving pressure and mortality of patients with acute respiratory distress syndrome (ARDS) varies across the adult lifespan, hypothesizing that it is stronger in older, including very old (⩾80 yr), patients. Methods: We performed a secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials ("ARDSNet cohort"). We tested our hypothesis in a second, independent, national cohort ("Hellenic cohort"). We performed both binary logistic and Cox regression analyses including the interaction term between age (as a continuous variable) and driving pressure at baseline (i.e., the day of trial enrollment) as the predictor and 90-day mortality as the dependent variable. Measurements and Main Results: On the basis of data from 4,567 patients with ARDS included in the ARDSNet cohort, we found that the effect of driving pressure on mortality depended on age (P = 0.01 for the interaction between age as a continuous variable and driving pressure). The difference in driving pressure between survivors and nonsurvivors significantly changed across the adult lifespan (P < 0.01). In both cohorts, a driving pressure threshold of 11 cm H2O was associated with mortality in very old patients. Conclusions: Data from randomized controlled trials with strict inclusion criteria suggest that the effect of driving pressure on the mortality of patients with ARDS may depend on age. These results may advocate for a personalized age-dependent mechanical ventilation approach. [ABSTRACT FROM AUTHOR]

Background: Long-term gender-specific survival and cancer incidence in patients with ruptured abdominal aortic aneurysm (rAAA) were investigated after endovascular (EVAR) and open repair (OAR). Methods: Data from 2933 patients (EVAR n = 1187, OAR n = 1746) from a health insurance company in Germany (men n = 2391, women n = 542) were analyzed. All patients were cancer-free in their history. Results: Perioperative mortality was significantly higher after OAR (42.6%) than after EVAR (21.2%; p < 0.001). Women had significantly higher in-hospital mortality (41.5%) than men (32.2%). Notably, the 5-year survival was 36.9% after OAR and 40.8% after EVAR (p < 0.001), and 40.7% in men and 29.1% in women (p < 0.001). Overall, 17.2% of EVAR and 14.6% of OAR patients had cancer at 5 years (p = 0.328). Cancer incidence did not differ significantly between men and women. Patients with cancer had a significantly less favorable outcome compared to patients with no cancer (p = 0.002). Treatment of rAAA was also indicated in octogenarians, with survival rates of 19.9% after 5 years and even 38.4% with perioperative deaths excluded. Conclusions: Cancer represents a significant risk factor for survival in patients with rAAA. These patients should be monitored during follow-up, particularly regarding the development of lung cancer. [ABSTRACT FROM AUTHOR]

Background: Octogenarians constitute the fastest-growing segment within contemporary cardiac surgery, yet precise risk assessment in this age group remains challenging. Aims: This study aimed to evaluate EuroSCORE II reliability in octogenarians undergoing isolated coronary surgery and to create an adjustment formula if necessary. Patients and Methods: All octogenarians who had isolated coronary surgery in Poland from January 2012 to December 2023, recorded in the Polish National Registry of Cardiac Surgical Procedures (KROK registry), were retrospectively assessed. EuroSCORE II's reliability was measured using the ROC curve area and observed-to-predicted mortality ratio, differentiating on-pump and off-pump cases. A nomogram was developed to enhance predictive accuracy. Results: Among 5771 octogenarians, 2729 (47.3%) underwent on-pump and 3042 (52.7%) underwent off-pump surgery. EuroSCORE II demonstrated reliability in off-pump patients (AUC:0.72, O/E ratio:0.98) but underestimated mortality for on-pump cases (AUC:0.73, O/E ratio:1.62). The lowest predicted mortality group (0.50–1.82%) showed the greatest discrepancies. Calibration was improved by adding a coefficient and creating a nomogram. Conclusions: EuroSCORE II was dependable in predicting outcomes for Polish octogenarians undergoing isolated coronary surgery. Observed mortality following on-pump surgeries was higher than expected, which was corrected by adding a coefficient to the initial EuroSCORE II calculation. [ABSTRACT FROM AUTHOR]

Background: Although pancreaticoduodenectomy (PD) for pancreatic or periampullary cancer is the gold standard treatment regardless of patient age, patients aged 80 years or older have poor postoperative short-term outcomes because of their poor functional status and many medical comorbidities. Postoperative rehabilitation in octogenarians could improve postoperative outcomes; however, its effect remains unclear. Methods: This retrospective study included patients who underwent PD at two institutions between January 2019 and December 2022. All patients were managed using the enhanced recovery after surgery (ERAS) protocol, and elderly patients or those with loss of muscle mass or frailty underwent additional perioperative rehabilitation. Postoperative short-term outcomes were compared between the octogenarians and non-octogenarians. Results: We reviewed 251 patients including 44 octogenarians (17.5%). Octogenarians had higher rates of comorbidity (78.9% vs. 55.1%, P = 0.049) and sarcopenia (31.8% vs. 16.4%, P = 0.018) and a more impaired nutritional status than non-octogenarians and received postoperative rehabilitation more frequently (86.4% vs. 44.0%, P < 0.001, respectively). Under the rehabilitation-enhanced ERAS protocol, the postoperative major complication rate (25.0% vs. 24.6%, P = 0.960), the length of hospital stay (LOS) (P = 0.435), and the length of functional recovery (LOFR) (P = 0.110) did not differ between the two groups. In the multivariate analysis, age ≥ 80 years was not determined as a risk factor for major complications. Conclusions: Despite the poor functional and nutritional status of octogenarians, their postoperative major complication rates, LOS, and LOFR after PD were comparable with those of non-octogenarians under the rehabilitation-enhanced ERAS protocol. [ABSTRACT FROM AUTHOR]

Introduction: Advances in health care have resulted in an increasing octogenarian population in the United States. The prevalence of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in this subgroup exceeds 70%. This study attempts to evaluate perioperative outcomes of different transurethral techniques in octogenarians and define their utilization trends from 2011 to 2022. Methods: We extracted data from the American College of Surgeons NSQIP for octogenarian patients who underwent prostatectomy for BPH. Procedures were categorized using CPT codes, and outcomes included postoperative complications, readmission, 30-day reoperation, and utilization trends from 2011 to 2022. Results: A total of 21,314 octogenarians were included. TURP was the most performed procedure (53.13–71.17%), followed by PVP and HoLEP. HoLEP utilization increased reaching up to 19% by year 2022. Higher American Society of Anesthesiologists (ASA) scores were observed more frequently in the TURP group. HoLEP consistently exhibits the longest operative times. Initially relatively higher transfusion rates for HoLEP decreased to 0% by 2022. Urinary tract infection rates did not significantly differ among the procedures most years. Results: TURP remained the most performed modality for BPH management in octogenarians amongst NSQIP-participating institutions. However, from 2011 to 2021, the utilization of HoLEP increased nearly by 2.5 folds, from 2.5 to 6.4%. [ABSTRACT FROM AUTHOR]

Objective: To compare postoperative stay in octogenarians and younger patients undergoing gynecologic oncology robot‐assisted surgery. Methods: A retrospective review of robot‐assisted surgery in Gynecological Oncology division during 2019–2022. We included all consecutive cases. Octogenarians (age ≥80 years) and younger patients were investigated by univariable analysis for characteristics and outcome. Results: A total of 816 robot‐assisted surgeries were performed, 426 (52.2%) endometrial cancer, 159 (19.5%) ovarian cancer, 27 (3.3%) cervical cancer, 35 (4.3%) endometrial intraepithelial neoplasia, and in 169 (20.7%) the final pathology was benign. There were 60 (7.4%) octogenarians and 756 (92.6%) younger patients. The proportion of patients with an American Society of Anesthesiology score greater than 2 was higher among octogenarians (66.7% vs 32.0%, P < 0.001). The median console time, surgical time, and total operation theater time were similar between groups (P = 0.303, P = 0.643 and P = 0.688, respectively). Conversion rate did not differ between groups (0.4% among younger patients vs 0% in octogenarians, P > 0.99). The median length of stay in the recovery room was similar in both groups (median 170 min, interquartile range [IQR] 125–225 min vs 170 min, IQR 128–240 min in octogenarians, P = 0.731). Length of hospital stay was similar in both age groups; median 1 day (IQR 1–1) among octogenarians versus 1 (0–1) in younger patients (P = 0.136). Conclusion: Octogenarians undergoing robotic surgery have no increased risk of length of stay or conversion to laparotomy compared with younger patients. Synopsis: Robot‐assisted surgery is safe in a gynecologic oncology aging patient population. [ABSTRACT FROM AUTHOR]

Background: There is interest in using bladder-preserving therapy as an alternative definitive therapy for muscle invasive bladder cancer in certain high-risk groups such as the elderly. Objective: To determine if bladder-preserving therapy represents a safer alternative to surgical intervention in elderly patients with muscle invasive bladder cancer. Methods: We surveyed the Surveillance, Epidemiology and End Results database (SEER) for cases of non-metastasized malignant bladder cancer in patients aged 80+. Survival outcomes with radical cystectomy (RC) with or without chemotherapy were compared to those after chemotherapy and radiation without cystectomy. We performed log-rank tests and Kaplan-Meier and cox regression and hazard analyses before and after propensity score matching. Results: A total of 2995 patients were identified, with 49.98% treated with RC only, 8.65% treated with RC/chemotherapy, and 41.37% treated with chemotherapy and radiation without RC. Median overall survival for the RC only, RC/chemotherapy and chemotherapy/radiation groups were 31.4, 44.1, and 24.6 months, respectively. On multivariate analysis, hazard ratios (reference: RC/chemotherapy group) were RC Only (HR = 1.408 (95% CI 1.188–1.669), p < 0.0001) and chemotherapy/radiation (HR = 1.650 (95% CI 1.390–1.959), p < 0.0001). After matching the chemotherapy/radiation and RC/chemotherapy groups, the former continued to show survival hazard (HR = 1.744 (95% CI 1.414–2.155), p < 0.0001). Conclusions: Octogenarians should be offered definitive local therapy for their localized bladder cancer including RC and chemotherapy. Bladder-sparing alternatives should be reserved for patients unfit for surgery. [ABSTRACT FROM AUTHOR]

Background: The data on acute cholangitis in the octogenarian population are very limited. This study aimed to examine the clinical characteristics of acute cholangitis and complications related to endoscopic retrograde cholangiopancreatography (ERCP) in octogenarians. Materials and Methods: This study was conducted prospectively between July 2022 and December 2023 and included 250 patients aged 65 years and older. Patients eligible for the study were divided into two groups: those aged ≥80 years (octogenarian) and those aged 65–79 years (non-octogenarian). These two groups were compared in terms of the clinical characteristics of cholangitis and ERCP-related complications. In addition, factors associated with in-hospital mortality were evaluated. Results: Out of 250 patients, 87 (34.8%) were octogenarians and 163 (65.2%) were non-octogenarians. The median age was 76 (69–82) years. Although the octogenarian group had higher rates of severe illness and intensive care unit admissions (p < 0.001 and p = 0.002, respectively), there were no significant differences in in-hospital mortality (p = 0.359) or ERCP-related complications (p = 0.417). Malignant etiology (odds ratio [OR]: 5.68, 95% confidence interval [CI]: 2.11–15.3), hypoalbuminemia (OR 0.18, 95% CI 0.07–0.45), and qSOFA score ≥ 2 (OR: 6.5, 95% CI: 1.7–24.5) were independent risk factors for in-hospital mortality. Conclusions: Being over 80 years old is not an indicator of poor outcomes, and ERCP can be safely performed on these patients. However, elderly patients with hypoalbuminemia, malignant etiology, or a qSOFA score of ≥2 should be closely monitored, regardless of their age. [ABSTRACT FROM AUTHOR]

Introduction: Thrombolysis and endovascular thrombectomy (EVT) are standard treatments after stroke. We previously reported that these therapies benefit stroke patients over 80 years old. Now, we aimed to study reperfusion therapies specifically in nonagenarians, hypothesizing a poorer prognosis in this group. Methods: Nonagenarian stroke patients were identified from our prospective monocentric cohort, which included consecutive patients ≥80 years old treated with thrombolysis and/or EVT from 2015 to 2019. Baseline characteristics, treatments, and outcomes, as well as complications and mortality were analyzed. Results: Ninety-six nonagenarians were treated with thrombolysis (69.8%) and/or EVT (81.1%). A total of 51% had a pre-stroke modified Rankin score (mRS) ≤2. Cardioembolism was the most common etiology (67.7%). Age was associated with a higher mRS after stroke with a turning point at 90 years old: (90–99 years old: odds ratio [OR] = 0.33, 95% confidence interval [95% CI]: 0.13–0.83, p = 0.02) versus (85–89 years old: OR = 0.72, 95% CI: 0.34–1.50, p = 0.38), with 80- to 84-year-old patients as the reference. In nonagenarians, previous coronary artery disease (OR = 8.02, 95% CI: 1.66–38.68, p = 0.01), initial National Institute of Health Stroke Score (NIHSS) (OR = 1.11, 95% CI: 1.03–1.19, p = 0.01), pre stroke independence (OR = 0.25, 95% CI: 0.08–0.71, p = 0.01), and “drip-and-ship” status (OR = 3.35, 95% CI: 1.22–9.16, p = 0.02) were associated with 3-month mortality. Nonagenarians had more baseline comorbidities (p = 0.003) and lower levels of pre-stroke independence (p = 0.002) than octogenarians (n = 261). Despite no difference in the use of acute treatments, timelines, and rates of successful reperfusion, a good functional status at 3 months was less common in nonagenarians than octogenarians (14.3% vs. 34.0%, p < 0.001) with a higher mortality (60.2% vs. 16.4%, p < 0.001). A total of 9.5% of nonagenarians experienced a symptomatic intracranial hemorrhage. Conclusions: Age is a crucial factor affecting prognosis after stroke with a turning point at 90 years old. However, age alone should not be a limiting factor for treatment decision. Despite higher mortality and poorer functional prognosis overall, some nonagenarians may benefit from reperfusion therapies. [ABSTRACT FROM AUTHOR]

Purpose: After the Tokyo 2018 guidelines (TG2018) were published, evidence from the 2018 CHOCOLATE RCT supported early cholecystectomy for acute cholecystitis (AC), even in high-risk patients. This study aims to investigate AC management at our tertiary care center in the years following these publications. Methods: A retrospective cohort study was performed on patients admitted from 2018 to 2023. AC severity was graded using TG2018 definitions. Comorbidities were summarized using Charlson Comorbidity Index (CCI) and frailty using the 5-item modified Frailty Index (5mFI). Compliance with TG2018 recommendations for management strategy was investigated. Outcomes were compared between patients who underwent surgery versus non-operative management (NOM). Subset analysis based on patients' age, frailty, and comorbidities was performed. Results: Among 642 AC patients, 57% underwent cholecystectomy and 43% NOM (22% percutaneous cholecystostomy, 21% antibiotics only). NOM patients had greater length of stay (LOS), complications, deaths, readmissions, and discharge to nursing/rehab versus surgery patients. In 70% of patients managed non-operatively, TG2018 were not followed. Patients managed non-operatively despite TG2018 were more likely to undergo delayed cholecystectomy compared to those in whom guidelines were followed (17% vs. 4%). In subset analysis, healthy octogenarians were significantly less likely to be managed according to TG2018 (9.4%); patients undergoing surgery had a trend towards shorter LOS (3.1 vs. 4.8 days) than those managed non-operatively but no difference in other outcomes. Conclusion: Most patients undergoing NOM could potentially undergo cholecystectomy if guidelines are considered. A more objective approach to risk assessment may optimize patient selection and outcomes. [ABSTRACT FROM AUTHOR]

Background: There is still limited evidence on the results of prehabilitation in very old frail patients. The aim of this study is to analyze the outcomes and course of octogenarian and nonagenarian patients undergoing prehabilitation before surgery for colorectal cancer (CRC). Methods: a prospective study was conducted in a tertiary hospital from 2018 to 2022. All patients diagnosed with CRC over 80 years old and proposed for surgery were included. A comprehensive geriatric assessment (CGA) for frailty detection was performed, and the therapeutic decision was taken by the multidisciplinary tumor committee. Prehabilitation led by the geriatric team was performed. The rate of medical and surgical complications, hospital stay, in-hospital mortality, and first-year mortality were recorded. Results: CRC surgery was proposed in 184 patients >80 years. After a multidisciplinary decision, surgery was performed on 126 (68.5%) patients, of whom 12 (0.5%) were nonagenarians. Fifty percent of octogenarians and 86% of nonagenarians were frail. Prehabilitation consisted of the following: adapted physical exercise (100%); oral nutritional supplementation (73.8%); anemia treatment (59.5%); delirium prevention (5.6%); antidepressant treatment (15.9%); vitamin D supplementation (21.4%); and pharmacological deprescription (38.1%). The post-surgical complication rate was low (4.3% surgical and 29.4% medical complications), and in-hospital mortality was very low (3.2%). Nonagenarian patients had a higher rate of complications compared to octogenarians (OR 4.0 (95% CI 1.13–14.12))—mainly heart failure (OR 4.68 (95% CI 1.21–18.09))—but there were no differences in hospital stay or first-year mortality. Conclusions: prehabilitation in very old patients with CRC surgery is possible and provides good results. [ABSTRACT FROM AUTHOR]

Background: Despite recent reports, the effectiveness of postoperative oral nutritional supplementation (ONS) on body weight loss and malnutrition after gastrectomy remains controversial. We aimed to elucidate the effectiveness of ONS especially in octogenarian patients undergoing oncological gastrectomy. Methods: A total of 286 consecutive patients who underwent gastrectomy for gastric cancer were eligible. Postoperative body weight loss, malnutrition, and sarcopenia were compared between patients with and without postoperative ONS among octogenarian patients aged ≥ 80 years and non-octogenarian patients aged < 80 years. Results: In this study, 36 (62.1%) octogenarian and 121 (53.1%) non-octogenarian patients continued postoperative ONS for three months. The clinicopathologic characteristics were not different between the ONS (−) and ONS (+) groups among the octogenarian and non-octogenarian patients. The changes in body weight and serum albumin levels at postoperative 1 year were different between the ONS (−) and ONS (+) groups (P = 0.03 and P = 0.04, respectively) among the octogenarian patients, but not between the two groups among the non-octogenarian patients (P = 0.99 and P = 0.29, respectively). Also, the decline in psoas muscle mass index at postoperative 6 months and 1 year was significantly lower in the ONS (+) group than in the ONS (−) group (P < 0.01 and P < 0.01, respectively). In addition, similar results were found in octogenarian patients who underwent distal gastrectomy. Conclusions: Postoperative ONS could prevent body weight loss, malnutrition, and sarcopenia especially in octogenarian patients who underwent gastrectomy for gastric cancer. [ABSTRACT FROM AUTHOR]

On 7 October, 2023 Israel was attacked over the Gaza border by Hamas terrorists. Mostly civilians, approximately 1,200 people were killed, with an additional 251 taken hostage (in addition to 4 abducted before October 7 for a total of 255 hostages), many of whom have since died. Of the total abducted, 13% were older than 65, a third of whom were octogenarians. Brief case histories of three abductees over 80 years of age are presented: two released and one still in captivity. The extreme "pre-morbid" vulnerability of these older hostages is described along with the additional data on their clinical situation and the extreme stresses to which they are being subjected. The situation described constitutes one of the most severe examples of elder abuse documented in the modern era. [ABSTRACT FROM AUTHOR]

Treatment outcomes of octogenarians with aneurysmal subarachnoid hemorrhage (aSAH) are often considered poor. With ongoing advancements and experience in endovascular technology, we sought to evaluate the outcomes of octogenarians treated for aSAH in the second post–International Subarachnoid Aneurysm Trial (ISAT)/Barrow Ruptured Aneurysm Trial (BRAT) decade. A single-center database of aSAH was reviewed to identify patients aged 80 years or above undergoing aneurysm treatment. Mortality and favorable neurologic outcome (defined as modified Rankin Scale score <3) were assessed among the series and compared across several subgroups. Octogenarian patients constituted 6% of the aSAH cohort (38 of 619) over the reviewed period. Twenty-one percent were high grade (Hunt-Hess grade 4–5). Endovascular treatment was the first-line modality in 90% of patients. During a median follow-up of 17 months, the overall mortality was 39%. Higher mortality was associated with poor Hunt-Hess grade (100% for grade 5, 47% for III-IV, 13% for 1–2, P = 0.004) and non-independent baseline function status (100% mortality for non-independent vs. 28% for independent group, P = 0.002). At last follow-up, 53% of patients achieved a favorable neurologic outcome. The stratified rate was 80% in Hunt-Hess grade I–II and over 60% in patients with premorbid independent function status or less than 5 frailty components (P ≤ 0.02 vs. poorer counterparts). Neurologic outcomes of octogenarian patients with aSAH are improving in the second post-trial decade, particularly given the preponderance of endovascular treatment. Baseline functional status and comorbidities of octogenarians should be considered in addition to the Hunt-Hess grade in prognostication. [ABSTRACT FROM AUTHOR]

Simple Summary: There is a significant gap in research and guidelines for treating octogenarian multiple myeloma (MM) patients. This retrospective study examined 101 MM patients, median age 84 years (80–98), treated outside clinical studies at TASMC between 2010 and 2023, aiming to review real-world practices and outcomes experienced by this vulnerable group of patients. Of these patients, 87% received a bortezomib-based regimen; 20% received lenalidomide ± bortezomib; 44% were treated with novel agent-based doublets, and 51% with triplets/quadruplets. Despite the employment of reduced doses of steroids and lenalidomide, treatment-related toxicity was high, including 9% who suffered grade 5 events. Of these patients, 67% received subsequent lines, resulting in an impressive median overall survival of 42 months (1–141) in the entire cohort. These results highlight the effectiveness of personalized therapy for octogenarian multiple myeloma (MM) patients and emphasize the need for further real-time studies to establish guidelines for the management of this vulnerable and growing population. Background: Data on the outcome of octogenarian multiple myeloma (MM) patients (pts), especially if treated outside clinical studies, are scanty. Aims and Methods: MM pts ≥ 80 years, treated at TASMC with first-line therapy between 2010 and 2023, were reviewed. Characteristics and outcomes were analyzed. Results: A total number of 101 pts, of whom 54 were males with a median age of 84 years (80–98), were included. Among them, 67.4% had a Charlson comorbidity index of ≥5, 37% had ISS-3 (International staging system) and 20% had Revised-ISS-3. In our study, 44.5% received doublets and 50.5% received triplets/quadruplets. A bortezomib-based regimen was applied in 87%, and IMiDs were used in 27.7%. Despite an upfront employment of a low lenalidomide dose, dose reductions were required in 48%. Grade ≥ 3 adverse events (AEs) (mainly infections) were documented in 36.6% of patients, including grade 5 events in 9%, all attributed to infections. The overall response rate was 69%, including 31% ≥ VGPRs (Very good partial response). Sixty-seven percent (67%) received second-line therapy, administered within a median period of 12 months (1–84). Within a median follow-up period of 36 m (1–141), the median overall survival (OS) approached 42 m (range: 1–141); being shorter in pts > 84 years (HR = 1.7, p = 0.03), pts with lung disease (HR = 1.8, p = 0.044) and pts with ISS = 3 and R-ISS = 3 (HR = 1.65, p = 0.0016 and HR = 2.45, p = 0.006, respectively); Conclusions: Octogenarians treated outside clinical studies often have a lower tolerance to treatment. Nevertheless, upfront administration of low doses of anti-MM agents provided a response in the majority of patients, translated into impressive OS. Nevertheless, mortality due to AEs was high, emphasizing the need for new, "octogenarian-oriented" treatment protocols. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option. Methods: This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery. Results: The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups. Conclusions: BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly. Clinical Relevance: This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients. [ABSTRACT FROM AUTHOR]

Abstract Background Although pancreaticoduodenectomy (PD) for pancreatic or periampullary cancer is the gold standard treatment regardless of patient age, patients aged 80 years or older have poor postoperative short-term outcomes because of their poor functional status and many medical comorbidities. Postoperative rehabilitation in octogenarians could improve postoperative outcomes; however, its effect remains unclear. Methods This retrospective study included patients who underwent PD at two institutions between January 2019 and December 2022. All patients were managed using the enhanced recovery after surgery (ERAS) protocol, and elderly patients or those with loss of muscle mass or frailty underwent additional perioperative rehabilitation. Postoperative short-term outcomes were compared between the octogenarians and non-octogenarians. Results We reviewed 251 patients including 44 octogenarians (17.5%). Octogenarians had higher rates of comorbidity (78.9% vs. 55.1%, P = 0.049) and sarcopenia (31.8% vs. 16.4%, P = 0.018) and a more impaired nutritional status than non-octogenarians and received postoperative rehabilitation more frequently (86.4% vs. 44.0%, P

Abstract Background The benefits and risks of coronary artery bypass grafting (CABG) in octogenarians remain unclear. This study aimed to identify the predictors of increased risk of all-cause mortality in octogenarian patients after CABG. Methods We retrospectively analyzed the data of 1636 octogenarians who underwent isolated elective on-pump CABG between 2007 and 2016. The primary endpoint was mortality from any cause. The Kaplan–Meier curve was generated for mortality. A univariate Cox regression was performed for preprocedural and procedural variables. The Akaike information criterion (AIC) using the Cox proportional hazard model was applied to determine the strongest predictors. We designed a nomogram based on the selected variables to calculate the mortality risk after one, five, and ten years. The bootstrap resampling based on the C-index was performed to validate the final model. Calibration plots were created at different time points. Results The mean age of the patients was 82.03 years (SD = 1.74), and 74% were male. In a median follow-up of 9.2 (95% CI 9.0,9.5) years, 626 (38.2%) patients died. After the selection of best predictors based on AIC, the multivariable Cox regression showed that ejection fraction

Abstract Background With the introduction of transcatheter aortic valve implantation, the role of surgical aortic valve replacement (SAVR) in elderly patients has been called into question. We investigated the short-term outcomes of SAVR in the elderly population. Methods All patients aged ≥ 70 years who underwent isolated SAVR in our centre between 2008 and 2017 were included in the study. Survival at 30 days and 1 year were compared for patients aged 70–79 years (n = 809) versus patients aged ≥ 80 years (n = 322). Factors associated with poorer survival outcomes were identified using multivariable Cox regression analysis. Results Patients aged 70–79 years and patients aged ≥ 80 years had similar survival rates at 30 days (98.1% vs. 98.4%, p = 0.732) and 1 year (96.0% vs. 94.1%, p = 0.162) post-SAVR. This remained true after multivariable adjustment. Risk factors for 30 day all-cause mortality included insulin dependent diabetes (HR 6.17, 95% CI 1.32–28.92, p = 0.021) and increasing cardiopulmonary bypass time (HR 2.72, 95% CI 1.89–3.91, p

Abstract Background Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the preferred first-line treatment for localized muscle-invasive bladder cancer (MIBC). In recent years, octogenarians have been undergoing RC uneventfully, but studies showed older adults receive NAC less often. We studied the utilization and effect of RC with or without NAC in octogenarians and compared survival outcomes between responders and non-responders. Methods In our retrospective study using the National Cancer Database (NCDB), we identified octogenarians with MIBC and urothelial histology who underwent RC with or without NAC between 2004 and 2018. The NAC cohort included patients who underwent RC with NAC, and the non-NAC cohort included those with or without adjuvant chemotherapy. The NAC cohort was subcategorized into responders and non-responders based on surgical pathology. Patients with comorbidity index > 1 were not included, thereby excluding patients with possible renal impairment. After propensity-matching, we compared the overall survival (OS) between NAC and non-NAC cohorts and responders and non-responders. Results 33924 patients underwent RC, and 3056 octogenarians met our selection. Among them, 396 received NAC, and 2660 did not receive NAC. Among those who received NAC, 112(28.3%) experienced downstaging, and 223(56.4%) exhibited upstaging or no change (p

The halo-shape technique (HST) is an emerging approach for implanting a leadless pacemaker in scoliosis patients in recent years. Severe scoliosis and humpback made it challenging to push the tip of the delivery catheter towards the ventricular septum using the conventional gooseneck-shape technique. The feasibility and safety of the use of HST in an octogenarian with severe dextroscoliosis and humpback have not been well-assessed. Here, we report a case of high-degree atrioventricular block octogenarian with severe dextroscoliosis and humpback who successfully received a leadless pacemaker implantation using HST. Procedure-related complications were not observed, and the electrical parameters were stable at 6-month follow-up. [ABSTRACT FROM AUTHOR]

Background and purpose: Large symptomatic Vestibular Schwannoma (VS) often requires surgical resection, regardless the patient's age. The aim of this study was to assess the surgical outcomes of patients in their ninth decade of life. Methods: This monocenter retrospective observational study included patients aged 80 years or older who underwent VS surgery between 2009 and 2020. We retrospectively analyzed their immediate post-surgical and long-term outcomes and complications. Results: Thirteen octogenarians who underwent VS surgery were included, with average age of 83.2 ± 1.97 years old (median 83.5, range 80–86 years). One patient had a Koos-Grade II tumor, and 12 patients had a grade IV. All patients had a preoperative ASA score ≤ 3 and underwent surgery in the supine position. Twelve patients underwent a pre-planned partial resection (PR) and one had a gross-total resection (GTR). Good facial function (House-Brackmann grade ≤ 2) was achieved in 10 patients (77%). We reported three Clavien-Dindo grade ≤ 3 treatment-related complications and no life-threatening complication. Two patients experienced tumor recurrence after PR. Conclusion: In this series of patients who underwent VS surgery in their ninth decade of life, surgical outcomes were acceptable. Therefore, age alone should not serve as a contraindication for surgery. Preplanned PR is a reasonable attitude in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a significant health concern, particularly among older adults. Outcomes between laparoscopic and robot-assisted surgeries for right-sided colon cancers in the oldest old population have yet to be evaluated despite increased use of these surgeries. Aim: This study aimed to compare clinical outcomes after robot-assisted right hemicolectomy (RARH) versus laparoscopic right hemicolectomy (LRH) in octogenarian and nonagenarian patients. Methods: This population-based, retrospective and observational study analyzed the data of adults ≥ 80 years old diagnosed with right-side colon cancer who received RARH or LRH. All data were extracted from the US National Inpatient Sample (NIS) database 2005–2018. Associations between type of surgery and in-hospital outcomes were determined using univariate and multivariable logistic regression and linear regression analysis. Results: Data of 7,550 patients (representing 37,126 hospitalized patients in the U.S.) were analyzed. Mean age of the study population was 84.8 years, 61.4% were females, and 79.1% were non-smokers. After adjusting for relevant confounders, regression analysis showed that patients undergoing RARH had a significantly shorter LOS (adjusted Beta (aBeta), -0.24, 95% CI: -0.32, -0.15) but greater total hospital costs (aBeta, 26.54, 95% CI: 24.64, 28.44) than patients undergoing LRH. No significant differences in mortality, perioperative complications, and risk of unfavorable discharge were observed between the two procedures (p > 0.05). Stratified analyses by frailty status revealed consistent results. Conclusions: RARH is associated with a significantly shorter LOS but higher total hospital costs than LRH among octogenarians and nonagenarians. Other short-term outcomes for this population are similar between the two procedures, including in-hospital mortality, perioperative complications, and unfavorable discharge. These findings also apply to frail patients. [ABSTRACT FROM AUTHOR]

In previous studies, using transcriptomic analysis, we observed higher levels of aryl hydrocarbon receptor (AHR) gene expression in the peripheral blood cells of centenarians compared to octogenarians. This suggests the potential significance of this receptor in maintaining physiological balance and promoting healthy aging, possibly linked to its critical role in detoxifying xenobiotics. In our current study, we confirmed that AHR expression is indeed higher in centenarians. We employed C. elegans as a model known for its suitability in longevity studies to explore whether the AHR pathway has a significant impact on lifespan and healthspan. Our survival assays revealed that two different mutants of AHR-1 exhibited lower longevity. Additionally, we used a mouse model to examine whether supplementation with pomegranate extract modulates the expression of AHR pathway genes in the liver. Furthermore, we studied a nutritional strategy based on pomegranate extract administration to investigate its potential modulation of life- and healthspan in worms. [ABSTRACT FROM AUTHOR]

Background: A decline in cognitive function is associated with inflammatory processes. However, the association between high-sensitivity C-reactive protein (hs-CRP) levels and cognitive decline in the Japanese population remains inconclusive. Thus, this study aimed to determine whether hs-CRP is associated with low cognitive function in 70- and 80-year-old community-dwelling Japanese individuals. Methods: The participants in this cross-sectional study were 872 Japanese residents aged 70 and 80 years who voluntarily participated in the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study between 2010 and 2011. Blood sample collection, cognitive assessment, and other measurements were performed at the venue. Low cognitive function was defined as a score of 25 points or lower on the Japanese version of the Montreal Cognitive Assessment. The odds ratio (OR) and 95% confidence interval (95% CI) for each hs-CRP quartile were calculated using logistic regression analysis. Results: A total of 288 (69.9%) parsons in the 70-year-old group and 372 (80.9%) in the 80-year-old group exhibited low cognitive function. The association between hs-CRP levels and low cognitive function was significant among 70- and 80-year-old Japanese community-dwelling adults. In particular, the fourth quartile of hs-CRP (0.727–7.420 mg/L) in the 70-year-old group and the second and fourth quartiles (0.214–0.404 and 0.911–9.890 mg/L) in the 80-year-old group were associated with low cognitive function. Furthermore, the third quartile (0.409–0.892 mg/L) in the 80-year-old group was closely associated with low cognitive function. Conclusions: High hs-CRP levels were associated with lower cognitive function in 70- and 80-year-old Japanese community-dwelling individuals, suggesting that high hs-CRP levels may influence cognitive function. [ABSTRACT FROM AUTHOR]

Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. Design Retrospective cohort study emulating a randomised target trial using electronic health records. Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was allcause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. Results A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95%CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95%CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being. [ABSTRACT FROM AUTHOR]

The use of robot-assisted laser interstitial thermal therapy (LITT) is emerging as a viable treatment option for brain tumors in patients aged 80–90 years (octogenarians). Correspondingly, the aim of this study was to describe the clinical feasibility of octogenarians undergoing LITT procedure for brain tumors at our institution. A retrospective review was conducted of all robot-assisted LITT procedures performed at our institution between 2013 and 2023 for octogenarians. Comparison of continuous variables was by Student t tests, and Kaplan-Meier estimates were used to estimate survival outcomes. A total of 20 of 311 (6%) LITT patients in the search cohort were octogenarians. Mean age was 82.6 years (range, 80.1–88.0 years) with 13 (65%) female patients. Brain tumor lesions most commonly were located on the left side (65%), and, for ablation, all were single trajectories with mean number of 2.3 ablations. No operative complications were seen during hospitalization, with mean length of stay of 1.6 days and most common disposition destination being home (95%). There were no 30- or 90-day readmissions or emergency department presentations. Mean follow-up was 12.4 months without any complications in that time. The most common pathology in our cohort was glioblastoma (55%). Robot-assisted LITT is a safe and effective treatment option for brain tumors in octogenarians with a very low morbidity risk. Therefore, further investigation is required to understand how LITT can translate to therapeutic benefit in patients aged over 80 years old with brain tumors. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of brain tumors has increased in elderly population overtime. Their eligibility to a major surgery remains a questionable subject. This study evaluated prognostic factors and 30-days morbidity and mortality in octogenarian population who underwent craniotomy for resection of brain tumor. Materials and methods: A total of 154 patients were divided into two different groups: patients above 80 years old and patients below 65 years old. In both groups, patients were stratified based on diagnosis with benign tumors [meningioma] and malignant tumors [high-grade gliomas and metastases]. Multivariable logistic regression model with backward elimination method was utilized to identify the independent risk factors for 30-days readmission and post-operative complications. Results: The analysis revealed no significant difference in 30-day readmission (p = 0.7329), 30-day mortality (0.6854) or in post-operative complication (p = 0.3291) between age ≥ 80 and age ≤ 65 groups. A longer length of stay (LOS) was observed in the older patients (p = 0.0479). There was a significant difference in the pre-post KPS between the two groups (p < 0.0001). ASA (p = 0.0315) and KPS (p = 0.071) were found as important prognostic factors associated with post-operative mortality in both groups. Conclusion: Octogenarians can withstand craniotomy without any significant increase in 30-day readmission, 30-day mortality and post-operative complications as compared to patients younger than age 65. The ASA score (>3) and/or KPS (<70) were the most important prognostic factors for 30-days readmission and mortality. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is a major health issue worldwide. As the population ages, more older patients including octogenarians will require CRC treatment. However, this vulnerable group has decreased functional reserves and increased surgical risks. Enhanced recovery after surgery (ERAS) pathways aim to reduce surgical stress and complications, but concerns remain about applying ERAS protocols to older patients. We assessed whether a modified ERAS (mERAS) protocol combined would improve outcomes in octogenarian CRC patients undergoing minimally invasive surgery. Methods: In this retrospective cohort study, we compared 360 non‐octogenarians aged 50–64 years and 114 octogenarians aged 80–89 years before and after mERAS protocol implementation. Outcomes including postoperative functionary recovery, length of stay, complications, emergency department visits, and readmissions were analyzed. Results: Despite comparable tumor characteristics, octogenarians had poorer nutrition, American Society of Anesthesiologists status, and more comorbidities. After mERAS, octogenarians had reduced complications, faster return of bowel function, and shorter postoperative length of stay, similar to non‐octogenarians. mERAS implementation improved recovery in both groups without increasing emergency department visits or readmissions. Conclusion: Although less remarkable than in non‐octogenarians, mERAS protocols mitigated higher complication rates and improved recovery in octogenarians after minimally invasive surgery for CRC, confirming protocol feasibility and safety in this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives: Plasma C-terminal agrin-fragment-22 (CAF22), a breakdown product of neuromuscular junction, is a potential biomarker of muscle loss. However, its levels from adolescence to octogenarians are unknown. Methods: We evaluated young (18–34 years, n = 203), middle-aged (35–59 years, n = 163), and old men (60–87 years, n = 143) for CAF22, handgrip strength (HGS), appendicular skeletal-mass index (ASMI), and gait speed. Results: We found an age-associated increase in CAF22 from young (100.9 ± 29 pmol) to middle-aged (128.3 ± 38.7 pmol) and older men (171.5 ± 35.5 pmol) (all p<0.05). This was accompanied by a gradual reduction in HGS (37.7 ± 6.1 kg, 30.2 ± 5.2 kg, and 26.6 ± 4.7 kg, for young, middle-aged, and old men, respectively), ASMI (8.02 ± 1.02 kg/m2, 7.65 ± 0.92 kg/m2, 6.87 ± 0.93 kg/m2, for young, middle-aged, and old men, respectively), and gait speed (1.29 ± 0.24 m/s, 1.05 ± 0.16 m/s, and 0.81 ± 0.13 m/s, for young, middle-aged, and old men, respectively). After adjustment for age, we found negative regressions of CAF22 with HGS (− 0.0574, p < 0.001) and gait speed (− 0.0162, p < 0.001) in the cumulative cohort. The receiver operating characteristics analysis revealed significant efficacy of plasma CAF22 in diagnosing muscle weakness (HGS < 27 kg) (middle-aged men; AUC = 0.731, 95% CI = 0.629–0.831, p < 0.001, Older men; AUC = 0.816, 95% CI = 0.761–0.833, p < 0.001), and low gait speed (0.8 m/s) (middle-aged men; AUC = 0.737, 95% CI = 0.602–0.871, p < 0.001, older men; AUC = 0.829, 95% CI = 0.772–0.886, p < 0.001), and a modest efficacy in diagnosing sarcopenia (middle-aged men; AUC = 0.701, 95% CI = 0.536–0.865, p = 0.032, older men; AUC = 0.822, 95% CI = 0.759–0.884, p < 0.001) in middle-aged and older men. Conclusion: Altogether, CAF22 increases with advancing age and may be a reliable marker of muscle weakness and low gait speed. [ABSTRACT FROM AUTHOR]

Tyrosine kinase inhibitors (TKIs) have greatly improved chronic myeloid leukemia (CML) treatments, with survival rates close to the general population. Yet, for the very elderly, robust data remains limited. This study focused on assessing comorbidities, treatment approaches, responses, and survival for elderly CML patients. Our study was conducted on 123 elderly (≥ 75 years) CML patients across four centers in Israel and Moffitt Cancer Center, USA. The median age at diagnosis was 79.1 years, with 44.7% being octogenarians. Comorbidities were very common; cardiovascular risk factors (60%), cardiovascular diseases (42%), with a median age-adjusted Charlson Comorbidity Index (aaCCI) of 5. Imatinib was the leading first-line therapy (69%), while the use of second-generation TKIs increased post-2010. Most patients achieved a major molecular response (MMR, 66.7%), and half achieved a deep molecular response (DMR, 50.4%). Over half (52.8%) of patients moved to second-line, and nearly a quarter (23.5%) to third-line treatments, primarily due to intolerance. Overall survival (OS) was notably longer in patients with an aaCCI score below 5, and in patients who attained DMR. Contrary to expectations, the Israeli cohort showed a shorter actual life expectancy than projected, suggesting a larger impact of CML on elderly survival. In summary, imatinib remains the main initial treatment, but second-generation TKIs are on the rise among elderly CML patients. Outcomes in elderly CML patients depend on comorbidities, TKI type, response, and age, underscoring the need for personalized therapy and additional research on TKI effectiveness and safety. [ABSTRACT FROM AUTHOR]

To examine the perioperative, postoperative, and long-term outcomes of fenestrated/branched endovascular aneurysm repair (F/BEVAR) in octogenarians compared with nonoctogenarians. A multicenter, retrospective cohort study was conducted using the Vascular Quality Improvement database, which prospectively captures information on patients who undergo vascular surgery across 1021 academic and community hospitals in North America. All patients who underwent F/BEVAR endovascular aortic repair from 2012 to 2022 were included. Patients were stratified into two groups: those aged <80 years and those aged ≥80 years at the time of the procedure. The preoperative, intraoperative, and postoperative factors were compared between the two groups. The primary outcome was long-term all-cause mortality; secondary outcomes included aortic-specific mortality and aortic-specific reintervention. A total of 6007 patients (aged <80 years, n = 4860; aged ≥80 years, n = 1147) who had undergone F/BEVAR procedures were included. No significant difference was found in technical success, postoperative length of stay, length of intensive care unit stay, postoperative bowel ischemia, and spinal cord ischemia. After adjustment for baseline covariates, octogenarians were more likely to suffer from a postoperative complication (odds ratio [OR]: 1.16; [95% confidence interval (CI): 0.98-1.37], P <.001) and be discharged to a rehabilitation center (OR: 1.60; [95% CI: 1.27-2.00], P <.001) or nursing home (OR: 2.23; [95% CI: 1.64-3.01], P <.001). Five-year survival was lower in octogenarians (83% vs 71%, hazard ratio [HR]: 1.70; [95% CI: 1.46-2.0], P <.0001). Multivariate Cox proportional hazard analysis demonstrated that age was associated with increased all-cause mortality (HR: 1.72, [95% CI: 1.39-2.12], P <.001) and aortic-specific mortality (HR: 1.92, [95% CI: 1.04-3.68], P =.038). Crawford extent II aortic disease was associated with an increase in all-cause mortality (HR 1.49; [95% CI: 1.01-2.19], P <.001), aortic-specific mortality (HR: 5.05; [95% CI: 1.35-18.9], P =.016), and aortic-specific reintervention (HR: 1.91; [95% CI: 1.24-2.93], P =.003). Functional dependence was associated with increased all-cause mortality (HR: 2.90; [95% CI: 1.87-4.51], P <.001) and aortic-specific mortality (HR: 4.93; [95% CI: 1.69-14.4], P =.004). Our findings suggest that octogenarians do have a mildly increased mortality rate and rate of adverse events after F/BEVAR procedures. Despite this, when adjusted for other risk factors, age is on par with other medical comorbidities and therefore should not be a strict exclusion criterion for F/BEVAR procedures, rather considered in the global context of patient's aortic anatomy, health, and functional status. [ABSTRACT FROM AUTHOR]

Objectives Grief is a human, universal, personal and multidimensional experience. Although studies have been conducted to describe grief, there is no consensus among scholars about its theoretical or empirical definition in older adults. This study aims to analyze the concept of grief in old age. Methods & Materials This is a review study that was conducted in eight steps using Walker and Avant's concept analysis method. To find studies related to grief in the elderly, a search in online databases including ScienceDirect, Scopus, PsychInfo, PubMed, Web of Science, and EMBASE using keywords: Grief, mourn, bereavement, old, geriatric, aging, age, later life, seniors, nonagenarian, octogenarian and centenarian. Also, articles were examined without considering the time limit published until January 30, 2023. The search strategy, screening, and data reporting were done based the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Results Of 5963 articles, 34 were included. According to the findings, grief had five features, "a unique phenomenon", "negative emotional experience", "physiological irritation", "experience of loneliness", and "loss of previous meanings". Three antecedents of grief included: Loss of loved ones, loss of pets, spouse divorce, and loss of health. Four consequences of grief included health consequences, social consequences, financial consequences, and resiliency. Conclusion The provided definition of grief in older adults can help the health team understand the concept better and carry out investigations, interventions, and evaluations to improve the health of the elderly. [ABSTRACT FROM AUTHOR]

Background Cor triatriatum sinister (CTS) is a rare congenital heart defect sometimes complicated with atrial fibrillation (AF). Catheter ablation (CA) relieves the AF-associated symptoms, but CA for AF with CTS has been reported rarely. Because CTS can be associated with other congenital heart disease, detailed preoperative assessment is important. Case summary An 80-year-old man was referred to our institution for shortness of breath that had persisted for 2 months when he was first diagnosed with AF. Transthoracic echocardiography revealed an enlarged left atrium (LA) divided into two chambers by a membrane. Transoesophageal echocardiography showed the membrane extending from the fossa ovalis (FO) to the Coumadin ridge, with the accessory (dorsal) chamber (AC) in closer proximity to the FO. Computed tomography showed that all pulmonary veins (PVs) flowed into the AC, with no PV anomalies. No other heart anomaly was identified, with no thrombus in the LA. With these findings, PV isolation (PVI) with CA was considered safe. Transseptal puncture was performed with intracardiac echocardiography for precise catheterization of the AC. Pulmonary vein isolation was performed successfully. The patient was discharged 4 days after the procedure, without any complications. His symptoms improved post-procedure, and sinus rhythm was maintained without antiarrhythmic drug therapy during the 18-month follow-up. Discussion Cor triatriatum sinister is a rare anomaly that accounts for 0.1% of all congenital heart diseases. Cor triatriatum sinister sometimes complicated with symptomatic AF. Detailed preoperative anatomical assessment with multiple imaging modalities helped us achieve safe and effective CA for a patient with AF and CTS, even in an octogenarian. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to assess the perioperative morbidity, mortality and long-term survival of octogenarians undergoing acute type A aortic dissection repair (ATAAD), and to compare open and closed distal anastomosis techniques. Methods: This was a single-centre retrospective study (2007–2021). Open versus closed distal anastomosis were compared. Uni- and multivariable logistic regression analyses were performed to identify independent predictors of in-hospital mortality. Kaplan–Meier and Cox proportional hazards methods were used to compare long-term survival. Results: Fifty octogenarian patients were included (median age—82 years; closed distal—22; open distal—28). Median cardiopulmonary bypass time was 187 min (open distal vs. closed distal group; 219 min vs. 115.5 min, p < 0.01, respectively). Median cross-clamp time was 93 min (IQR; 76–130 min). Median circulatory arrest time was 26 min (IQR; 20–39 min) in the open-distal group. In-hospital mortality was 18% (open distal; 14.2% vs. closed distal; 22.7%, p = 0.44). Stroke was 26% (open distal; 28.6% vs. closed distal; 22.7%, p = 0.64). Median survival was 7.2 years (IQR; 4.5–11.6 years). Survival was comparable between open and closed distal groups (median 10.6 vs. 7.2 years, p = 0.35, respectively). Critical preoperative status (HR; 3.2, p = 0.03) and composite endpoint (renal replacement therapy, new neurological event, length of stay > 30 days or return to theatre; HR; 4.1, p = 0.02) predicted adverse survival. Open distal anastomosis did no impact survival. Conclusions: ATAAD repair in selected octogenarians has acceptable short- and long-term survival. There is no significant difference between open versus closed distal anastomosis strategies. [ABSTRACT FROM AUTHOR]

Background: Limited information is available on the safety and efficacy of cryoballoon ablation (CBA) in elderly patients with atrial fibrillation (AF). Moreover, global utilization of CBA in this population (≥ 80 years old) has not been reported. This study's objectives were to determine the use, efficacy, and safety of CBA to treat octogenarians suffering from AF. Methods: In this sub-analysis of the Cryo Global Registry, 12-month outcomes of treating AF via CBA in octogenarians were compared to patients < 80 years old. Efficacy was evaluated as time to a ≥ 30 s atrial arrhythmia (AA) recurrence. Healthcare utilization was determined via repeat ablations and hospitalizations. Improvement upon disease burden was evaluated through patient reporting of symptoms and the EQ-5D-3L quality of life (QoL) survey. Results: The octogenarian cohort (n = 101) had a higher prevalence of females (51.5% vs 35.7%) and CHA2DS2-VASc scores (4.2 ± 1.3 vs 2.0 ± 1.5) compared to the control cohort (n = 1573, both p < 0.01). Even when adjusting for baseline characteristics and antiarrhythmic drug usage, freedom from AA recurrence at 12 months (80.6% vs 78.9%, HRadj:0.97 [95% CI:0.59–1.58], p = 0.90) was comparable between octogenarians and control, respectively. Similar serious adverse event rates were observed between octogenarians (5.0%) and control (3.2%, p = 0.38). The groups did not differ in healthcare utilization nor reduction of AF-related symptoms from baseline to follow-up, but both experienced an improvement in QoL at 12 months. Conclusions: Despite more age-related comorbidities, CBA is a safe and effective treatment for AF in octogenarians, with efficacy and adverse events rates akin to ablations performed in younger patients. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02752737 [ABSTRACT FROM AUTHOR]

This study aimed to achieve two primary objectives. Firstly, to compare physical fitness levels based on sex, age groups, and body composition. Secondly, to examine physical fitness of the older adults against criterion-referenced fitness standard values using a representative sample from the district of Leiria in Portugal, a region undergoing exponential population growth, including a rise in the elderly population. Data from cross-sectional assessments of the Portuguese older adult community living in the Municipality of Leiria from 2014 to 2022 were collected. This study comprised a sample of 664 community-dwelling older adults (female = 480; male = 184) aged between 60 and 90 years (M = 70.34; SD = 12.67). Participants had a body mass ranging from 45 kg to 122 kg (M = 71.48; SD = 12.34) and a height ranging from 1.30 m to 1.89 m (M = 1.59; SD = 0.08). The Senior Fitness Test battery was used to evaluate parameters of physical fitness, body mass index was calculated, and abdominal circumference was measured. Females displayed a tendency to greater physical fitness compared to males, specifically in terms of lower and upper body flexibility compared to older male adults (p < 0.05). In addition, sexagenarian and older adults with normal weight tended to display greater physical fitness compared to septuagenarian and octogenarian, and overweight adults and those with obesity (p < 0.05), respectively. Information concerning physical fitness is crucial for guiding policymakers and other stakeholders in Leiria for the promotion of healthy aging among the older adult community. Furthermore, this study has established the preliminary reference standards for physical fitness, serving as a tool to promote healthy aging among Portuguese older adults residing in Leiria. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion Although the prevalence of heart failure (HF) increases markedly with advancing age, surprisingly little is known about HF in the very elderly. The aim of this study was to describe the clinical characteristics and outcomes of octogenarians with HF.Individual participant meta‐analysis of patients with HF and reduced, mildly reduced, and preserved ejection fraction (HFrEF, HFmrEF, and HFpEF, respectively) enrolled in eight large randomized trials. Overall, the proportion of octogenarians was 1518 of 20 168 patients (7.5%) with HFrEF, 610 of 4609 (13.2%) with HFmrEF, and 3130 of 15 354 (20.4%) with HFpEF. Regardless of HF phenotype, octogenarian patients were more often female and had more comorbidities, more symptoms and signs of congestion, and worse health status (but not quality of life), in comparison to patients aged <80 years. The incidence (per 100 person‐years) of the composite of cardiovascular death or HF hospitalization was 13.3 (95% confidence interval [CI] 12.7–14.0) in octogenarians versus 9.5 (95% CI 9.3–9.7) in non‐octogenarians (adjusted hazard ratio [aHR] 1.40, 95% CI 1.32–1.48). Each component of the composite was more frequent in octogenarians with rates of cardiovascular mortality of 7.0 (95% CI 6.5–7.4) per 100 person‐years versus 4.9 (95% CI 4.8–5.1) in non‐octogenarians (aHR 1.60, 95% CI 1.48–1.72, p < 0.001). Octogenarians received less evidence‐based therapy, especially mineralocorticoid receptor antagonists, than younger patients.Despite worse health status and higher hospitalization and mortality rates, octogenarians were undertreated compared to younger patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: The demographic shift towards an aging population necessitates a reevaluation of surgical interventions like coronary artery bypass grafting (CABG) in octogenarians. This study aims to elucidate the outcomes of CABG in octogenarians with heart failure and reduced ejection fraction (HFrEF), a group traditionally considered at high risk for such procedures. Methods: Conducted across four academic hospitals in Germany from 2017 to 2023, this retrospective multicenter study assessed 100 patients (50 octogenarians ≥80 years and 50 non-octogenarians <80 years) with HFrEF undergoing isolated CABG. Through propensity score matching, the study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCEs), as well as other clinical endpoints, between the two groups. Statistical analyses included chi-square, ANOVA, Mann–Whitney U test, Cox regression, and logistic regression, aiming to identify significant differences in outcomes. Results: The study revealed no significant difference in the combined incidence of MACCEs between octogenarians and non-octogenarians (OR: 0.790, 95% CI: 0.174–3.576, p = 0.759). Mortality rates were similar across groups (7% each, p = 1.000), as were occurrences of postoperative myocardial infarction (2% each, p = 1.000) and stroke (3% total). Secondary outcomes like delirium (17% total, no significant age group difference, p = 0.755), acute kidney injury (18% total, p = 0.664), and the need for dialysis (14% total, p = 1.000) also showed no differences between age groups. Interestingly, non-octogenarians required more packed red blood cells during their stay (p = 0.008), while other postoperative care metrics, such as hospital and ICU length of stay and ventilation hours, were comparable across groups. Conclusion: This multicenter study highlights that CABG is a viable and safe surgical option for octogenarians with HFrEF, challenging prior assumptions about the elevated risks associated with performing this procedure in older patients. The absence of significant differences in the incidence of MACCEs and other postoperative complications across age groups emphasizes the importance of careful patient selection and perioperative management. These findings advocate for a more inclusive approach to surgical treatment for octogenarians with HFrEF, suggesting that age alone should not be a determinant for CABG eligibility. This study contributes critical insights into optimizing care for a high-risk demographic, indicating a need for tailored guidelines that accommodate the aging population with complex cardiac conditions. [ABSTRACT FROM AUTHOR]

Background: Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. Aims: To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. Methods: The Minimum Data Set for Home Care (MDS−HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0−100). Results: The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94–0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93–0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16–0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15–0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16–0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97–0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96–0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96–0.99, p < 0.001). Discussion: This is the first study using an MDS−HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. Conclusions: Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians. [ABSTRACT FROM AUTHOR]

Aim: This study aims to identify the key risk factors that lead to subtypes of physical frailty assessed by walking speed and grip strength among community‐dwelling Japanese individuals, stratified by the presence of musculoskeletal diseases (MSDs) and age group. Methods: We included 302 participants aged 70 or 80 years who did not exhibit subtypes of physical frailty at baseline through the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Our study was a longitudinal study. The outcome was the incidence of subtypes of physical frailty after 3 years. Subtypes of physical frailty were defined as a weak grip strength or slow walking speed, or both, based on the Japanese version of the Cardiovascular Health Study Index. The risk factors for subtypes of physical frailty incidence were examined by age group and MSD, using multivariate logistic regressions. Results: Of the 302 participants, 110 (36.4%) had MSD. Those with MSD were significantly more likely to have subtypes of physical frailty after 3 years compared with those without MSD. Among all participants, older age was a risk factor of subtypes of physical frailty (P < 0.05). Without MSD, older age and dissatisfied financial status were risk factors (P < 0.05). With MSD, older age was a risk factor (P < 0.05). By age group, in individuals aged 70 years old, a dissatisfied financial status was a risk factor for those without MSD (P < 0.05), and a higher BMI was one for those with MSD (P < 0.05). Conclusions: Older age was a risk factor for subtypes of physical frailty, but other risk factors differed according to the presence of MSD and age. Geriatr Gerontol Int 2024; 24: 797–805. [ABSTRACT FROM AUTHOR]

Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the link between physical performance and long-term survival in a cohort of community-dwelling older people from the "Aging and Longevity in the Sirente Geographic Area" study. Topics discussed include the methods used in the study, the definition of long-term survival, and the implications of the study for assessing mortality risk in octogenarians.

Objective The percentage of older adults living into their 80s and beyond is expanding rapidly. Characterization of typical cognitive performance in this population is complicated by a dearth of normative data for the oldest old. Additionally, little attention has been paid to other aspects of health, such as motor, sensory, and emotional functioning, that may interact with cognitive changes to predict quality of life and well-being. The current study used the NIH Toolbox (NIHTB) to determine age group differences between persons aged 65–84 and 85+ with normal cognition. Method Participants were recruited in two age bands (i.e. 65–84 and 85+). All participants completed the NIHTB Cognition, Motor, Sensation, and Emotion modules. Independent-samples t -tests determined age group differences with post-hoc adjustments using Bonferroni corrections. All subtest and composite scores were then regressed on age and other demographic covariates. Results The 65–84 group obtained significantly higher scores than the 85+ group across all cognitive measures except oral reading, all motor measures except gait speed, and all sensation measures except pain interference. Age remained a significant predictor after controlling for covariates. Age was not significantly associated with differences in emotion scores. Conclusions Results support the use of the NIHTB in persons over 85 with normal cognition. As expected, fluid reasoning abilities and certain motor and sensory functions decreased with age in the oldest old. Inclusion of motor and sensation batteries is warranted when studying trajectories of aging in the oldest old to allow for multidimensional characterization of health. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate surgical outcomes in octogenarians with subaxial cervical spine injuries and determine the predictors of complications and mortality. Methods: Eligible for inclusion were all patients surgically treated between 2006 and 2018, with either anterior or posterior fixation for subaxial spine injuries. A cohort of octogenarians was identified and matched 1:1 to a corresponding cohort of younger adults. Primary outcomes were perioperative complications and mortality. Results: Fifty-four patients were included in each of the octogenarian and younger groups (median age: 84.0 vs. 38.5). While the risks for surgical complications, including dural tears and wound infections, were similar between groups, the risks of postoperative medical complications, including respiratory or urinary tract infections, were significantly higher among the elderly (p < 0.05). Additionally, there were no differences in operative time (p = 0.625) or estimated blood loss (p = 0.403) between groups. The 30 and 90-day mortality rates were significantly higher among the elderly (p = 0.004 and p < 0.001). These differences were due to comorbidities in the octogenarian cohort as they were revoked when propensity score matching was performed to account for the differences in American Society of Anesthesiology (ASA) grade. Multivariable logistic regression revealed age and ASA score to be independent predictors of complications and the 90-day mortality, respectively. Conclusions: Octogenarians with comorbidities were more susceptible to postoperative complications, explaining the increased short-term mortality in this group. However, octogenarians without comorbidities had similar outcomes compared to the younger patients, indicating that overall health, including comorbidities, rather than chronological age should be considered in surgical decision-making. [ABSTRACT FROM AUTHOR]

Introduction: Heme oxygenase-1 (HO-1) is a stress-inducible heat shock protein (HSP32) that exerts cytoprotective effects against oxidative stress and inflammation, and is involved in the maintenance of cellular homeostasis. This study aimed to evaluate the expression of HO-1 in natural killer (NK) cells from individuals of different age groups after stimulation with various factors, and to analyze the relationships between the concentration of this cytoprotective protein and parameters corresponding to oxidative stress and inflammation, that is, NOD-like receptor protein 3 (NLRP3), glutathione (GSH), GSH disulfide (GSSG), and interleukin 6 (IL-6). Methods: The study population comprised three age groups: young adults (age range, 19-23 years), older adults aged under 85 years (age range, 73-84 years), and older adults aged over 85 years (age range, 85-92 years). NLRP3, GSH, and GSSG concentrations were measured in serum, whereas the HO-1 concentration and IL-6 expression were studied in NK cells cultivated for 48 h and stimulated with IL-2, lipopolysaccharide (LPS), or phorbol 12-myristate 13-acetate (PMA) with ionomycin. Results: The analysis of serum NLRP3, GSH, and GSSG concentrations revealed no statistically significant differences among the studied age groups. However, some typical trends of aging were observed, such as a decrease in GSH concentration and an increase in both GSSG level, and GSSG/GSH ratio. The highest basal expression of IL-6 and lowest basal content of HO-1 were found in NK cells of adults over 85 years of age. The NK cells in this age group also showed the highest sensitivity to stimulation with the applied factors. Moreover, statistically significant negative correlations were observed between HO-1 and IL-6 expression levels in the studied NK cells. Conclusions: These results showed that NK cells can express HO-1 at a basal level, which was significantly increased in activated cells, even in the oldest group of adults. The reciprocal relationship between HO-1 and IL-6 expression suggests a negative feedback loop between these parameters. [ABSTRACT FROM AUTHOR]

Background: With the introduction of transcatheter aortic valve implantation, the role of surgical aortic valve replacement (SAVR) in elderly patients has been called into question. We investigated the short-term outcomes of SAVR in the elderly population. Methods: All patients aged ≥ 70 years who underwent isolated SAVR in our centre between 2008 and 2017 were included in the study. Survival at 30 days and 1 year were compared for patients aged 70–79 years (n = 809) versus patients aged ≥ 80 years (n = 322). Factors associated with poorer survival outcomes were identified using multivariable Cox regression analysis. Results: Patients aged 70–79 years and patients aged ≥ 80 years had similar survival rates at 30 days (98.1% vs. 98.4%, p = 0.732) and 1 year (96.0% vs. 94.1%, p = 0.162) post-SAVR. This remained true after multivariable adjustment. Risk factors for 30 day all-cause mortality included insulin dependent diabetes (HR 6.17, 95% CI 1.32–28.92, p = 0.021) and increasing cardiopulmonary bypass time (HR 2.72, 95% CI 1.89–3.91, p < 0.0001). Significant risk factors for 1 year all-cause mortality were New York Heart Association (NYHA) class IV (HR 6.25, 95% CI 1.55–25.24, p = 0.010) and longer cardiopulmonary bypass time (HR 1.94, 95% CI 1.40–2.69, p < 0.0001). Similar results were obtained for cardiac-specific mortality. Conclusions: Short-term outcomes of SAVR are excellent in elderly patients and age alone is not a predictor of poorer outcomes. However, the increased risk of mortality in patients with insulin-dependent diabetes and those with severe functional impairment (NYHA class IV) should be carefully considered when selecting patients for SAVR in this elderly population. [ABSTRACT FROM AUTHOR]