Under-use of adjuvant chemotherapy in women aged ≥70 years diagnosed with breast cancer in a university hospital

Introduction

Patient age often limits the therapeutic efforts of the oncologist. The aim of this study was to determine whether chemotherapy is used less frequently in elderly women aged 65-69 years diagnosed with breast cancer, compared to younger women.

Methods

A retrospective study was performed including women greater than 65 years old who had localised breast cancer and were treated at a University Hospital. Patients were classified into two groups, 65-69 years old and ≥ 70 years old. The differences in patient characteristics, tumour characteristics, chemotherapy treatment and chemotherapy-associated toxicity were analysed in both groups.

Results

A total of 164 women, with an average age of 73.7 years, were included in this study. There were no significant differences in the characteristics of the patients or their tumours. However, 75% of women <70 years old were treated with chemotherapy compared to just 34% of the older women (P<.001). The resulting levels of toxicity were similar between age groups.

Conclusions

Women ≥ 70 years old were treated with chemotherapy less frequently, even though the features and tumour characteristics of the women, as well as the toxicity of the treatment, were similar to that in younger women.     

El déficit de vitamina B12 y ácido fólico en la población mayor de 65 años: estudio descriptivo

Introduction

The aim of this study is to establish the prevalence of vitamin B12 and folic acid deficiency in the population of 65 years and over in semi-urban and rural area, as well as investigating the risk factors, and the determining factors of this deficiency in this population and its relationship with the prevalence of concomitant cardiovascular and cognitive diseases.

Materials and methods

A cross-sectrionall study conducted in the Geriatrics Outpatients in the period between 2008 and 2010. Demographic, clinical and laboratory were collected at 3 different times.A bivariate analysis was performed with lack of vitamin B12 and folic acid, as the outcome variables.

Results

Vitamin B12 defieciency was found in 16.5% of the sample, and no folic acid deficiency. A strong association was found with vitamin B12 deficiency and cardiac and cerebrovascular diseases, vascular risk factors and drugs administered in prevention of cardiac events and ischaemic stroke.

Conclusions

There was a higher prevalence of vitamin B12 deficiency in the elderly population in the catchment area of Medina del Campo compared to that found in the literature, but not so with the isolated deficiency of folic acid.     

Lupus eritematoso sistémico en el anciano

Late-onset systemic lupus erythematosus (SLE) usually appears in patients older than 65 years and has clinical features different from the classical form observed in younger patients. In the elderly, SLE represents 10-20% of all SLE cases, shows a different and less aggressive clinical evolution and the first manifestations are non-specific. A significantly higher incidence of late-onset SLE in males, and the fact that postmenopausal women have a more benign disease, suggests that the estrogenic status may influence the activity of the disease. Owing to the insidious onset and the non-specific clinical manifestations on presentation, there is commonly a delayed diagnosis of late-onset SLE. Furthermore, the presence of comorbidities and concomitant therapies in elderly patients may limit the therapeutic options for SLE. The treatment of choice of joint symptoms and serositis includes non-steroidal anti-inflammatory drugs and low-dose steroids for short periods. In addition to the need for adopting a multidisciplinary approach, it is fundamental to obtain information about the functional, cognitive and social status of these patients in order to make appropriate healthcare decisions.     

Problemas de seguridad relacionados con la aplicación de dispositivos de restricción física en personas mayores

The use of physical restraint devices on frail elderly could have significant negative consequences on their health. Apart from complications due to prolonged immobility, the use of this procedure is associated with other serious adverse effects which occur when a person is restricted in a position which carries a risk of asphyxiation. The devices most implicated in these incidents are bedrails, vests and restraining belts. Physical restraint could also be associated as much with the sudden death of patients, due to the stress that it causes, as with injuries from falling. This article presents the recommendations which experts, manufacturers and institutions dealing with the quality of health care have issued for the safest use of this procedure. It stresses the need for better training of professionals, as well as the importance of investigating the factors which can lead to accidents with the aim of preventing them.     

Infradiagnóstico de enfermedades neuromusculares en ancianos de 80 y más años

Myasthenia gravis (MG), amyotrophic lateral sclerosis and Guillain-Barre syndrome (GBS) have been classically considered as exceptional or unusual diseases in people with a geriatric profile. Over the past 25 years, several population-based studies have been conducted in the Osona area (Barcelona), which, for the first time, has led to describing the high global incidences in the elderly, especially those over 80 years-old. The results suggest the possibility of underdiagnosis of these neuromuscular diseases in the elderly, a fact that could be especially relevant in the case of MG and GBS, since they are 2 potentially reversible entities with high mortality in the event of underdiagnosis and absence of treatment.     

Trasplante renal en mayores de 60 años en un hospital de Colombia

Introduction

Kidney transplantation is the treatment of choice in patients with end- stage renal disease. Renal transplantation in without fear of ethical conflicts is the best treatment option in the elderly. The objective is to describe the demographic and clinical characteristics of patients over 60 years old with at least one year of renal transplantation in a single center of Colombia.

Methods

This is a cohort study of patients over 60 years old from a single center in Bogota, Colombia. About 28 patients were analyzed between June 2004 and March 2012.

Results

The mean age was 65 years old, with 89% males. The main cause of chronic kidney disease was diabetic nephropathy, followed by hypertensive nephrosclerosis. Most of them (96.4%) were deceased donor transplants with a mean age of 40 years old, cold ischemia time was 12 hours and there was a mismatch of 3.25 (±1.29). Major comorbidities were hypertension, diabetes, dyslipidemia, and coronary arterial disease. Almost 17% had delayed graft dysfunction. Serum creatinine at 6 and 12 months was 1.27 mg/dl (±0.31) and 1.25 mg/dl (±0.33), respectively. Only 10% of patients had acute cellular rejection. Humoral rejections were not documented. The patient survival at 1 year was 89.7%, and death-censored graft survival was 96.4%. The most frequent cause of death was acute myocardial infarction.

Conclusions

Proper selection of kidney transplant recipients shows satisfactory results in survival, with low morbidity in patients older than 60 years.     

Deterioro funcional asociado al deterioro cognitivo en el anciano hospitalizado

Introduction

The aim of this study was to analyse the effect of cognitive impairment on functional decline in hospitalised patients aged ≥ 60 years.

Experiencia de una Unidad de Prevención de Caídas de un hospital de cuidados intermedios

Introduction

The aim of this study is to determine clinical features and interventions in patients attended in our hospital falls prevention unit.

Material and methods

Medical records and evaluation protocols from October 2010 to June 2012 were reviewed. Results are expressed in means and standard deviation.

Results

We studied 68 patients: 53 came due to falls (77.9%), and 15 (22%) due to gait disorders. The mean age was 77.6±7.9. Number of women: 63 (92.6%). Previous Barthel Index was 94/100, cognitive impairment 23 (33.8%), polypharmacy 69.1%, orthostatic hypotension 18 (26.4%). Walking speed 0.66± 0.19 m/s and Time up and go to (TUG) 16.6±4.5 s. Post-urography detected vestibular dysfunction in 34 patients (77%). Clinical cause of fall and/or gait disorder was multifactorial in 33 (48.5%), Parkinsonism 19 (27.9%), chronic pain/arthropathy 8 (11.4%), and vestibular syndrome 8 (11.4%). Two-thirds (45; 66.1%) of the patients began Physical therapy, and vitamin D was given to 47 (69.1%). Phone calls were made to patients and/or their relatives and noted that after 3 months of the treatment: 48 (70.5%) had no fall; 59 (86.7%) patients followed the recommendations, and 57 (83.8%) were satisfied.

Conclusions

In this sample of older patients, mostly female with a good functional and cognitive condition, the causes of the falls were multifactorial in the half of the cases, and the post-urography detected vestibular changes in the half of the patients.