Background Population aging will be one of humanity’s major challenges in the decades to come. In addition to focusing on the pathologies causing the greatest mortality and morbidity in this population, such as dementia, health research in elderly people must consider a myriad of other interlinked factors, such as geriatric syndromes, social aspects, and factors related to preserving quality of life and promoting healthy aging. This study aims to identify the main subject areas attracting research attention with regard to very old (≥ 80 years) populations. Methods Documents assigned with the medical subject heading “Aged, 80 and over” were retrieved from MEDLINE and the Web of Science. This dataset was used to determine publication output by disease, geographic region, country, and discipline. A co-word analysis was undertaken to identify thematic research clusters. Results Since the mid-2000s, there has been a boom in scientific output focusing specifically on very old populations, especially in Europe (43.7% of the documents) but also in North America (30.5%) and Asia (26%); other regions made only nominal contributions (0.5 to 4.4%). The USA produced the most research, while the most growth over the study period occurred in Japan, Spain, and China. Four broad thematic clusters were identified: a) geriatric diseases, health services for the aged, and social and psychological issues of aging; b) cardiovascular diseases; c) neoplasms, and d) bacterial infections & anti-bacterial agents. Conclusions Scientific research in very old populations covers a wide variety of interrelated topics. In quantitative terms, the top subject areas have to do with cardiovascular and cerebrovascular diseases (including aortic valve stenosis and stroke), dementia, and neoplasms. However, other degenerative pathologies, geriatric syndromes, and different social and psychosocial aspects also attract considerable interest. It is necessary to promote more equal participation in global research on pathologies and topics related to very elderly populations, as the highest rates of population aging and the largest numbers of elderly people in the next decades will be in low- and middle-income countries.
Objective SLE has a great clinical heterogeneity and low prevalence, thus making the development of recommendations or clinical practice guidelines (CPG) based on high-quality evidence difficult. In the last few years, several CPG appeared addressing the management of the disease. The aim of this review is to critically compare the recommendations made in the most recent CPG and to analyse and compare their methodological quality. Methods The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to compare the methodological quality of each of the CPG. Results Most CPG agreed in the general management and first-line treatment recommendations where there is higher quality evidence and disagreed in refractory disease treatment where there is lack of quality evidence. Also, the CPG are agreed in whether a patient should be treated regarding the most severe clinical manifestation or taking into account the treatment that best serves all clinical manifestations. The majority of the appraised CPG scored high-quality ratings, especially for scope and purpose and clarity of presentation, while they were of less quality when assessing applicability of each CPG. Conclusion CPG should aid, but not replace, the health professional’s clinical judgment in daily clinical patient management.
Background The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. Methods Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. Results There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). Conclusions Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.
(1) Background: The aging population poses challenges for hospital systems. Aortic stenosis is among the most frequent diseases in very old patients. The aim of this study was to describe gender and age differences in the clinical characteristics of very old patients hospitalized with aortic stenosis (AoS) in Spain from 2016 to 2019. (2): Methods: A retrospective observational study analyzing data from the national surveillance system for hospital data. Variables analyzed were age group, sex, length of stay, deaths, and comorbidity. (3) Results: The analysis included 46,967 discharges. Altogether, 7.6% of the admissions ended in death. The main reason for admission was heart failure (34.3%), and this increased with age (80–84 years: 26% versus 95–99 years: 56.6%; p < 0.001). The main treatment procedure was the transcatheter aortic valve replacement (12.7%), performed in 14.3% of patients aged 80–84 versus 0.5% in patients aged 95–99 (p < 0.001). In the multivariable analysis, women were admitted with more comorbidities (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.06–1.20). Mortality was similar, albeit women were admitted less for syncope (OR 0.83, 95% CI 0.74–0.93). Women also underwent fewer coronary catheterizations (OR 0.81, 95% CI 0.77–0.87) and echocardiograms (OR 0.96, 95% CI 0.94–0.98). (4) Conclusions: Aortic stenosis leads to a high number of hospital admissions. Women with AoS presented more heart failure and less cardiovascular pathology than men. Also, women are admitted with fewer episodes of syncope and have fewer ultrasounds and catheterizations.
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