Archives of gerontology and geriatrics
-
Arch Gerontol Geriatr · Mar 2003
Comparative StudyAge-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rat.
The aim of the present study was to define the age-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rats. For this purpose, laryngeal tissue sections obtained from 12-, 24- and 35-month-old F344/N rats were compared with respect to the density, distribution and morphology of various types of sensory and secretomotor nerve endings immunoreactive for protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP) and substance P (SP). Two distinct forms of PGP 9.5-immunoreactive motor end-plates were noted; the large sized motor end-plates localized in thyroarytenoid and cricoarytenoid muscles were degenerated in aged rats, while the small sized motor end-plates, localized predominantly in vocal muscles, did not show any age-related changes. ⋯ CGRP- and SP-immunostained taste bud-nerve endings were noted in 12- and 24-month-old rats, but only rarely in 35-month-old rats. The laryngeal epithelium contained PGP 9.5-, CGRP- and SP-immunoreactive thin free nerve endings with many varicosities; their number and distribution were similar between 12- and 24-month-old rats, while only a few endings were observed in 35-month-old rats. Our results indicated that ageing is associated with the reduction of laryngeal sensory and secretomotor nerve endings.
-
Arch Gerontol Geriatr · Jan 2003
Comparative StudyThe unfavorable nature of preoperative delirium in elderly hip fractured patients.
The onset of delirium is frequent in elderly patients who sustain hip fractures. The purpose of this study was to characterize different patterns of preoperative and postoperative delirium, to study factors associated with preoperative delirium and to evaluate the possible different outcome of these patients. This retrospective study comprised 281 elderly patients with hip fractures undergoing surgical fixation. ⋯ Regression analysis showed that prefracture dementia, prefracture mobility and low MMSE scores were strongly associated with higher probability of having preoperative delirium, with no additional effect of other variables. It is concluded that preoperative delirium should be viewed as a separate entity with unfavorable nature and adverse outcome. Careful preventive measures and better treating strategies should be employed to avoid this clinical condition.
-
Arch Gerontol Geriatr · Nov 2002
Exposure to opioid analgesia in cognitively impaired and delirious elderly hip fracture patients.
The objectives of this study were to characterize patterns of opioid analgesia in elderly hip fracture patients, to investigate the possible differences in the treatment of cognitively impaired, delirious, or cognitively intact patients, and to study the factors that may affect the doses received by such patients. This retrospective study comprised 184 elderly patients with hip fractures undergoing surgical fixation. Data collection included age, sex, length of stay, type of fracture, cognitive status by mini-mental state examination, assessment of possible delirium by the confusion assessment method, type and doses of opioid received by these patients. ⋯ Other parameters such as age, length of stay and type of fracture, had no effect on the use of opioid analgesia. It is concluded that the management of pain in older persons with hip fracture surgery is suboptimal with regards to insufficient administration of opioid analgesia in demented and delirious patients. The adoption of a standardized protocol for pain control may help in reducing the extent of this problem.
-
Arch Gerontol Geriatr · Jul 1998
Impending paradoxical embolism through a patent foramen ovale in an octogenarian with pulmonary embolism: detection by transesophageal echocardiography and successful treatment by anticoagulation.
Paradoxical embolism through a patent foramen ovale (PFO), an increasingly recognized cause of cryptogenic stroke and peripheral embolism, is believed to play little role in the elderly, mainly based on retrospective studies on selected populations. Paradoxical embolism is mostly a presumptive diagnosis, while definite demonstration of a thrombus crossing a PFO is rare. We describe the case of an 84-year-old patient with pulmonary embolism in whom a thrombus in transit through a PFO was found by transesophageal echocardiography (TEE). ⋯ Its prompt diagnosis may allow effective treatment even with medical therapy alone. We suggest that paradoxical embolism may be not so rare in the elderly. The apparent decline in prevalence with age may be the result of less extensive diagnostic assessment in the elderly, as compared to younger patients.
-
Arch Gerontol Geriatr · Mar 1997
Randomized Controlled Trial Clinical TrialImprovement of sleep quality by controlled-release melatonin in benzodiazepine-treated elderly insomniacs.
Benzodiazepines are widely used in the elderly population for the initiation of sleep. However, very frequently, complaints about poor sleep maintenance persist despite benzodiazepine treatment. Melatonin, a hormone produced by the pineal gland at night, is involved in the regulation of the sleep/wake cycle. ⋯ Subjects' sleep was assessed by wrist actigraphy. Melatonin treatment significantly increased sleep efficiency and total sleep time and decreased wake after sleep onset, sleep latency, number of awakenings and fragmental index, as compared to placebo. The results of our study indicate that melatonin replacement therapy can improve sleep quality in the elderly and that the beneficial effects are augmented in the presence of benzodiazepines.