Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.
Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valvereplacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Departmentof Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 femalepatients with their age of 65-76 （68.6±6.8） years. There were 55 patients with hypertension，38 patients with type 2 diabetes，and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP，Part I） and Duke Activity StatuIndex （DASI） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received，all the patients were divided into two groups with 45 patients in each group: biological valve group and mechanical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiopulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posteriorleaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge，QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge，NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge，but NHP and DASI of the biological valve group was significantly better than those at the 1st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biologicalvalve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.
Objective To evaluate the cardiovascular risk for non-cardiac thoracic surgery （NCTS） in elderly patients with dobutamine stress echocardiography and to decrease surgical risk for NCTS in the geriatrics. Methods Dobutamine stress echocardiography was used for cardiovascular evaluation in 32 NCTS candidates aged over 65 years. Patients with positive echocardiography underwent coronary angiography. Postoperative course and all complications were carefully recorded for the study. Results No serious cardiovascular events occurred during the test except for atrial or ventricular premature contracts in 5 cases. In 2 patients （6.7%,2/30） dobutamine test was positive and coronary artery occlusion was proved by further angiography. Thoracotomy was performed in 28 cases, including 2 cases with dubious result at dobutamine test. Cardiopulmonary complications occurred in 13 patients （46.4%,13/28） after surgery. Supraventricular tachyarrhythmia was the most common complication, occurred in 8 patients （28.6%,8/28）. One of the 2 patients with dubious result at dobutamine test developed definitive angina in the 5th postoperative day. The negative predictive value of dobutamine test was 100%. Conclusion Dobutamine stress echocardiography is a safe and effective method to evaluate major cardiovascular risk of NCTS in the geriatrics. But it is not predictive of tachyarrhythmia after surgery.
Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). Methods From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparingtechnique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures includedpain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. Results Theaverage length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with anaverage of about 4 months. At 1 year follow-up, 83% (n=20) of patients felt no pain and 17% (n=4) of patients had mildpain; 83% of patient can gain a flexion range of more than 100°; according to Mayo elbow performance score, the meanscores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of typeA fracture was significantly better than that of type B and C (P=0.034). Four patients had postoperative compl ications.Conclusion Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functionalresult and bony union despite of age.
To evaluate the efficacy and safety of comprehensive prophylaxis for deep venous thrombosis(DVT) after proximal femur fractures in geriatric patients. Methods From July 2003 to May 2006, 157 geriatric patients with proximal femur fractures treated with operation were divided into prophylaxis group and control group randomly. There were 82 patients (34 males, 48 females, aged 65-97 years) in prophylaxis group, 30 with femoral neck fracture and 52 with intertrochanteric fracture of femur. There were 75 patients (33 males, 42 females, aged 65-94 years) in control group, 28 with femoral neck fracture and 47 with intertrochanteric fracture of femur. In the prophylaxis group, comprehensive prophylaxis for DVT which included Aspirin, fibrinolytic enzyme, passive and active circumduction of the foot and ankle, CPM management wasappl ied. In the control group, no thromboproxylaxis was taken. All patients in the both groups received color doppler flow imaging (CDFI) examination before operation and on the 7th and 14th days after operation. Results CDFI found 2 cases of DVT in the prophylaxis group 7 and 14 days after operation respectively, while 21 and 15 cases of DVT in the control group respectively. The incidence of DVT was 48.0% in the control group compared with 4.9% in the prophylaxis group and the reduction was significant (P lt; 0.01). One patient gave up the intervention due to Melena 3 days after operation in the prophylaxis group. In the control group, 1 patient died 8 days after operation and another died 11 days after operation. Both died of acute pulmonary embol ism confirmed by autopsy. Conclusion The comprehensive prophylaxis can significantly decrease the incidence of DVT in geriatric patients after proximal femur fractures. There is no significant adverse effect during the intervention.
Objective To assess the risk factors associated with postoperative infection after elective abdominal operation for elderly in department of general surgery. Methods One hundred and fifty-nine consecutive elderly patients admitted to the department of general surgery in our hospital for elective abdominal operation between May 2010 and February 2012 were considered for inclusion and retrospectively analyzed. Thirty-eight patients （23.90%）with postoperative infection were taken as the infection group and 121 patients without postoperative infection as noninfection group. The differences in the objective physiological indicators， subjective health status indicators， operation status， the incidence of postoperative infective complications， and mortality were compared between the two groups. Results Of enrolled 159 patients in this study， the incidence of postoperative infective complications was 23.90% （38/159）； 2 patients died， and the postoperative mortality rate was 1.26%. Single factor and multivariate logistic regression analysis showed that preoperative malnutrition risk， history of diabetes， and chronic respiratory system disease were the independent risk factors of postoperative infection complications in elective abdominal surgery for elderly patients. Conclusion Improving preoperative respiratory function， diabetes mellitus， and nutritional status would help to reduce incidence of postoperative infection for elderly patients with elective abdominal operation.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
ObjectiveTo analyze the methods and effects of the reformation of undergraduate course of geriatric nursing in China. MethodsIn the spring semester of 2012 and 2013, we implemented the experiential scenario teaching and autonomous group learning with simulation and heuristic teaching method, and the nursing undergraduates were given scale of Kogan's attitude toward older people and Palmore's Facts on Aging Quiz 1 for investigation. The attitude to and knowledge on the elderly were compared before and after the study. Meanwhile, we also surveyed the interest in geriatric nursing among the students. ResultsThe interest in, attitude to and knowledge on the elderly among the students increased considerably after the teaching reformation. ConclusionThe undergraduate course teaching reformation of geriatric nursing with the simulation and heuristic teaching method has achieved good effects, and it can be widely used in geriatric nursing teaching in China. In the future, the reformation should focus on improving the students' professional interests and career choice.
The aging of the population has generated significant challenges and unprecedented opportunities for the development of geriatrics in China. The core idea of its overall concept, treatment according to syndrome differentiation and the characteristics of " preventive treatment of disease” have unique advantages, which are required to be explored and studied. This paper reviewed the development history of modern geriatrics in the west and China, analyzed and summarized the research hotspots in the field of integrated traditional Chinese and western medicine for geriatrics in the past five years. It then described the current development status and advantages of integrated traditional Chinese and western medicine in the treatment of common clinical geriatric diseases. Finally, it summarized and visioned the development of integrated traditional Chinese and western medicine for geriatrics.
One of the problems of aging is the large increase in the number of disabled elderly people. Due to the complex causes of disability and cognitive impairment caused by aging, acute and chronic diseases, the integrated care mode of comprehensive geriatric assessment and interdisciplinary team work should be adopted in the rehabilitation treatment. In the acute, post-acute and subacute phase of the elderly disease, long-term care and end of life care should be patient-centered, and the whole seamless continuous rehabilitation medical services should be provided; the methods of rehabilitation include professional intensive rehabilitation training in rehabilitation hospitals, general physical rehabilitation training in communities and families, as well as active use of big data research and artificial intelligence technology support. The ultimate goal is to maintain and improve functions and the quality of life of the elderly.