Self‐Reported Outcomes in Individuals Aged 65 and Older Admitted for Treatment to an Acute Care Surgical Service: A 6‐Month Prospective Cohort Study

Ali, Talal F.; Warkentin, Lindsey M.; Gazala, Sayf; Wagg, Adrian; Padwal, Raj; Khadaroo, Rachel G.

doi:10.1111/jgs.13783

Cited by 12 publications

(9 citation statements)

References 33 publications

(61 reference statements)

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“…With bladder cancer ranges among all cancers with the highest median age at diagnosis and as demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise [1, 8, 9, 18]. Incidence of bladder cancer increases with age and is 11-fold higher in patients ≥65 versus <65 years, while UCB mortality is reported to be even 16-fold higher in the elderly population [18, 19].…”

Section: Discussionmentioning

confidence: 99%

“…During the last century, life expectancy in western civilization has increased. By 2040, 1 in 4 Americans will be over the age of 65, most likely leading to a higher incidence of bladder cancer diagnosis at an advanced age [8, 9]. Regarding the data, urologists are often faced with the difficult decision of performing complex surgery in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

et al. 2020

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With a median age at diagnosis of 73 years, bladder cancer has the highest median age of all cancers. Age alone seems to be an independent risk factor for developing the disease with peak age advancing into the range of 85 years. As demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise. We, therefore, analyzed a contemporary radical cystectomy (RC) series at a single high-volume center on patients undergoing RC for urothelial carcinoma of the bladder (UCB). We aim to evaluate the feasibility of RC in the oldest-old patient cohort by assessing perioperative complications and long-term outcome. Materials and Methods: We retrospectively analyzed data of 1,278 consecutive patients who underwent RC for UCB at our tertiary referral center between 2004 and 2019. A total of 408 patients were aged 75-97 years at the time of RC and were further divided into 2 groups: 75-84 years of age (group 1) and ≥85 years of age (group 2). Median follow-up was 23 months. Outcome was analyzed using the χ 2 test, Mann-Whitney U test, Kaplan-Meier method, and log-rank test. Results: Perioperative Clavien-Dindo grade ≥III complications were seen in 25.1% (92/366) of group 1 patients and 35.7% (15/42) of group 2 patients (p = 0.073). Thirty-and 90-day mortality was 3.3 and 8.7% in group 1 and 4.8 and 14.3% in group 2 (p = 0.617 and p = 0.242, respectively). Three-year overall survival was 54.6% in group 1 and 31.3% in group 2 (p = 0.03). Three-year cancer-specific survival was 64.8% in group 1 and 38.8% in group 2 (p = 0.037). Recurrence-free survival was 105 months in group 1 and 12 months in group 2 (p = 0.039). Conclusion: In light of increasing life expectancy in western nations, we sought to evaluate the impact of age in a large series of elderly patients undergoing RC for UCB. We found that RC offers acceptable perioperative complication rates in the oldest-old patient cohort (≥85 years). Therefore, RC for UCB can be offered as a viable treatment option even in the oldest patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

et al. 2020

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“…Second, despite the recent hospitalisation, older patients with cardiovascular disease still improved in vulnerability to a degree that was lower (ie, better) than their prehospitalisation baseline. In natural conditions without interventions, community-dwelling older adults are more likely to increase (rather than decrease) in their functional decline 39. As such, the high prevalence of baseline vulnerability among HHC-referred patients (67%) indicates that their natural trajectory of postdischarge vulnerability change would be more likely to be worsening than improving, if no interventions had been provided.…”

Section: Discussionmentioning

confidence: 99%

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

et al. 2019

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Objectives(1) To compare changes in vulnerability after hospital discharge among older patients with cardiovascular disease who were discharged home with self-care versus a home healthcare (HHC) referral and (2) to examine factors associated with changes in vulnerability in this period.DesignSecondary analysis of longitudinal data from a cohort study.Participants and setting834 older (≥65 years) patients hospitalised for acute coronary syndromes and/or acute decompensated heart failure who were discharged home with self-care (n=713) or an HHC referral (n=121).OutcomeVulnerability was measured using Vulnerable Elders Survey 13 (VES-13) at baseline (prior to hospital admission) and 30 days and/or 90 days after hospital discharge. Effects of HHC referral on postdischarge change in vulnerability were examined using three linear regression approaches, with potential confounding on HHC referral adjusted by propensity score matching.ResultsOverall, 44.4% of the participants were vulnerable at prehospitalisation baseline and 34.4% were vulnerable at 90 days after hospital discharge. Compared with self-care patients, HHC-referred patients were more vulnerable at baseline (66.9% vs 40.3%), had more increase (worsening) in VES-13 score change (B=−1.34(–2.07, –0.61), p<0.001) in the initial 30 days and more decrease (improvement) in VES-13 score change (B=0.83(0.20, 1.45), p=0.01) from 30 to 90 days after hospital discharge. Baseline vulnerability and the HHC referral attributed to 14%–16% of the variance in vulnerability change during the 90 postdischarge days, and 6% was attributed by patient age, race (African-American), depressive symptoms, and outpatient visits and hospitalisations in the past year.ConclusionAfter adjusting for preceding vulnerability and covariates, older hospitalised patients with cardiovascular disease referred to HHC had delayed recovery in vulnerability in first initial 30 days after hospital discharge and greater improvement in vulnerability from 30 to 90 days after hospital discharge. HHC seemed to facilitate improvement in vulnerability among older patients with cardiovascular disease from 30 to 90 days after hospital discharge.

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“…The ability to perform activities of daily living was assessed using the Barthel Index (BI), which is a valid and reliable tool. The maximum score is 100 and the higher scores represent greater independence ( Ali et al, 2015 ). The COP-based parameters, BBS, FES-I, and BI were tested by a therapist initially and after 3 months of balance training.…”

Section: Methodsmentioning

confidence: 99%

Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial

Wang

Liang

et al. 2018

PeerJ

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BackgroundForce platform training with functional electric stimulation aimed at improving balance may be effective in fall prevention for older adults. Aim of the study is to evaluate the effects of the visual-feedback-based force platform balance training with functional electric stimulation on balance and fall prevention in older adults.MethodsA single-centre, unblinded, randomized controlled trial was conducted. One hundred and twenty older adults were randomly allocated to two groups: the control group (n = 60, one-leg standing balance exercise, 12 min/d) or the intervention group (n = 60, force platform training with functional electric stimulation, 12 min/d). The training was provided 15 days a month for 3 months by physical therapists. Medial–lateral and anterior–posterior maximal range of sway with eyes open and closed, the Berg Balance Scale, the Barthel Index, the Falls Efficacy scale-International were assessed at baseline and after the 3-month intervention. A fall diary was kept by each participant during the 6-month follow-up.ResultsOn comparing the two groups, the intervention group showed significantly decreased (p < 0.01) medial–lateral and anterior–posterior maximal range of sway with eyes open and closed. There was significantly higher improvement in the Berg Balance Scale (p < 0.05), the Barthel Index (p < 0.05) and the Falls Efficacy Scale-International (p < 0.05), along with significantly lesser number of injurious fallers (p < 0.05), number of fallers (p < 0.05), and fall rates (p < 0.05) during the 6-month follow-up in the intervention group.ConclusionThis study showed that the visual feedback-based force platform training with functional electric stimulation improved balance and prevented falls in older adults.

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Self‐Reported Outcomes in Individuals Aged 65 and Older Admitted for Treatment to an Acute Care Surgical Service: A 6‐Month Prospective Cohort Study

Abstract: There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.

Cited by 12 publications

References 33 publications

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

Changes in vulnerability among older patients with cardiovascular disease in the first 90 days after hospital discharge: A secondary analysis of a cohort study

Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial

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