Summary
Background : Percutaneous endoscopic gastrostomy tubes are placed with high frequency and relative safety for a variety of indications. One of these indications is temporary nutritional support for patients expected to resume oral nutrition.
Aims : To determine if baseline clinical characteristics can predict which patients attain the clinical goal of resuming oral nutrition with consequent tube removal.
Methods : We conducted a single site observational cohort study from December 1999 to April 2001, enrolling all patients scheduled for percutaneous endoscopic gastrostomy placement. Standard descriptive and bivariate analyses were performed. Cox proportional hazard models were constructed to identify patient characteristics prior to percutaneous endoscopic gastrostomy placement that might predict resumption of oral nutrition with tube removal.
Results : Bivariate analyses revealed four potential clinical predictors: age <65 years, localized head and neck cancer, serum albumin ≥3.75 g/dL, and serum creatinine ≤1.1 mg/dL. In multivariable analysis, age < 65 years (HR = 3.7, 95% CI: 1.0–14.3) and a diagnosis of localized head and neck cancer (HR = 4.6, 95% CI: 1.4–15.0) predicted resumption of oral nutrition with percutaneous endoscopic gastrostomy removal.
Conclusions : When discussing percutaneous endoscopic gastrostomy placement, doctors should consider the likelihood of achieving clinically important outcomes such as the resumption of oral nutrition with tube removal. This clinical goal is unlikely for older patients with diagnoses other than localized head and neck cancer.
Older people had worse functional ability at ICU admission, but the proportion of older people who recovered and their rate of recovery was the same as for younger people. Baseline functional status, rather than abnormal physiologic status (as measured by APACHE II) on admission, was the major determinant of recovery, whereas APACHE II was the main correlate of mortality. Together, baseline function and physiologic status provide valuable complementary information for clinically relevant outcomes following an ICU admission.
Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098–1106, 2020
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