Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Sep 2010
Acute medical management of the non-ST-segment elevation acute coronary syndromes (NSTE-ACS) in older patients.
Older patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represent many clinical challenges. For example diagnosis can be difficult, and comorbidities are common. Furthermore, NSTE-ACS is particularly common in older patients (>60% of acute myocardial infarctions occurring in patients aged 65 years or older) and the mortality associated with NSTE-ACS is particularly high. ⋯ Furthermore, the lack of clear clinical evidence in this population means that the current treatment guidelines do not fully address the needs of elderly patients. Several recent clinical trials have highlighted some of the main considerations we should make when treating elderly patients with NSTE-ACS. Different therapy options in the pharmacological management of NSTE-ACS in this age group are also discussed.
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Arch Gerontol Geriatr · Sep 2010
Comfort for the dying: five year retrospective and one year prospective studies of end of life experiences.
Many cultures have reported end-of-life experiences (ELEs) as part of the dying process. However, few studies have examined the mental states of the dying in the weeks and days before death. Following an ELE pilot study with a palliative care team, 38 nurses, doctors and end-of-life carers from two hospices and a nursing home took part in a 5-year retrospective followed by a 1-year prospective ELE study. ⋯ Most expressed concern about a lack of specialist ELE training and education and recommended that ELE modules be included in their training courses. ELEs provided comfort and hope for the dying and consolation for the bereaved. Further research is required to find the true prevalence and range of ELE phenomena.
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Arch Gerontol Geriatr · Sep 2010
Factors affecting mortality of frail hip-fractured elderly patients.
Hip fracture in the elderly may lead to increased morbidity and mortality. We assessed factors affecting mortality of frail elderly hip-fractured patients during the first 2 years after discharge from a post-acute rehabilitation program. Included were 376 patients admitted from 1/2006 to 9/2007. ⋯ Multivariate analysis showed that only dementia and age were independent predictors of mortality in the studied group. Multidisciplinary teams should be aware of treatable variables affecting these patients' survival and should endeavor to improve their functional and nutritional level. Moreover, expectation coordination should be carried out with very old and cognitively impaired patients.