Hip fractures in elderly patients are the most severe form of fragility fractures. They can lead to significant morbidity and mortality; additionally, they have an enormous economic and social burden. Treatment of hip fractures in elderly patients should be based on a prompt initial evaluation, followed by surgical treatment without unnecessary delays under a collaborative effort of a multidisciplinary team. Postoperative care should be started immediately after surgery, and it must include an intensive rehabilitation, as well as treatment of osteoporosis and any other metabolic imbalance. This review incorporates current literature on initial evaluation and definitive management of hip fractures in the elderly and is intended to assist practitioners of different specialties treating these patients.
We reviewed the literature on the pharmacological characteristics and role of donepezil in Alzheimer disease. We performed an evidence-based review of randomized controlled trials by searching sources such as PubMed, MEDLINE, Google Scholar, and Clinical Key. In total, 18 randomized clinical trials were identified. In amnestic mild cognitive impairment (MCI), data showed that donepezil delays progression to Alzheimer disease. However, for mild-to-moderate and moderate-to-severe Alzheimer disease, it proved effective in slowing cognitive and global function decline. Discontinuation of donepezil results in acceleration of disease progression. The effects of donepezil on behavioral symptoms have shown mixed outcomes. Donepezil is the standard of care in Alzheimer disease as it is well tolerated and has self-limiting gastrointestinal adverse effects. In amnestic MCI, off-label use of donepezil can be considered after risk stratification of conversion to Alzheimer disease.
Sarcopenia, characterized by a progressive loss of skeletal muscle mass and strength that occurs with advancing age, has been associated with falls, fracture, disability, and mortality. Depending on the definitions used, the prevalence in 60- to 80-year old population is reported as 0.9%–35.9%, while the prevalence ranges from 7%–70.0% in people older than 80 years. Sarcopenia has been associated with lower quality of life. Well-designed exercise interventions, particularly resistance training as well as nutritional supplementation, have been proved to improve muscle strength and performance in geriatric populations. Resistance training may also enhance quality of life. However, there are limited data on the effects of nutritional supplementation as an intervention on quality of life among individuals with sarcopenia. This review briefly summarizes the relationship between sarcopenia and quality of life and presents the potential of interventions to improve muscle quality, physical performance, and quality of life.
BACKGROUND: It is well known that incidence of gastrointestinal (GI) disease increases with age. Endoscopy for the evaluation of upper gastrointestinal (UGI) symptoms in elderly patients frequently provides useful diagnostic information.OBJECTIVES: To ascertain the indications for and describe the outcomes of upper gastrointestinal endoscopy in older patients (65+ years) referred to King Fahd Central Hospital (KFCH), Jazan, South West Saudi Arabia.METHODS: This is a retrospective, descriptive, cross-sectional hospital-based study conducted at KFCH. Records of 591 elderly patients were reviewed during the period of 11 years from 1994 to 2005. Indications for and diagnoses from upper gastrointestinal endoscopy were statistically analyzed.RESULTS: The mean age of patients studied was 73.5 years, with men representing 64.8% (n = 383). The most common indications for upper gastrointestinal endoscopy were: UGI bleeding, indicated by hematemesis or melena (139, 23.5%); epigastric pain (67, 11.3%); and acid peptic disease (60, 10.2%). Gastritis was the most common finding of the procedure, with no significant differences between males (20.9%) and females (23.6%). Esophageal varices was the second most common upper GI endoscopy finding among the study participants (102, 17.3).CONCLUSIONS: The most common indications for upper gastrointestinal endoscopy were UGI bleeding, epigastric pain and Acid Peptic Disease, Gastritis and esophageal varices were the most common findings of upper GI endoscopies performed in the studied population.
