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Outcome and Factors Associated with Mortality of Elderly Who Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest: Comparative Study between More and Less than 60 Years Old.

Soo bock LEE ; Yong Su LIM ; Jin Seong CHO ; Jin Joo KIM ; Jae Kwang KIM ; Sung Youl HYUN ; Hyuk Jun YANG ; Gun LEE

Journal of the Korean Geriatrics Society.2009;13(4):203-214. doi:10.4235/jkgs.2009.13.4.203

BACKGROUND: Therapeutic hypothermia (TH) has recently been recommended and widely used in post-resuscitated patients after cardiac arrest. In Korea, however, the use and study of this method are rare. We investigated outcomes and factors associated with survival in elderly patients who received TH after out-of-hospital cardiac arrest (OHCA). METHODS: We reviewed the cases of 38 elderly (> or =60 years) and 50 younger (<60 years) patients who received TH after OHCA from January 2007 to December 2008. We compared the outcomes and factors associated with mortality in the pre-, intra- and post- cardiac arrest periods of both groups. RESULTS: The elderly (> or =60 years) had higher mortality (22 [57.9%] vs 15 [30.0%], p=0.023) and poorer neurological outcome (34 [89.4%] vs 36 [60.0%], p=0.002) than the younger patients (<60 years). Factors associated with survival in the elderly were arrest at home (31.3% vs 63.2%, p=0.049), pH (7.16+/-0.18 vs 7.00+/-0.13, p=0.008), base deficits (-11.26 +/- 4.74 vs -15.33 +/- 5.50 mmol/L, p=0.029) and lactate level (7.75 +/- 2.87 vs 10.7 +/- 3.58 mmol/L, p=0.013) while pH (7.13 +/- 0.16 vs 6.99 +/- 0.14, p=0.028) and APACHE II scores (19.46 +/- 5.70 vs 24.13 +/- 4.44, p=0.005) affected survival in the younger patients. However, there was no significant difference in complications related to TH. In logistic regression analysis, factors related to mortality at 1 month were age, time from collapse to Advanced Cardiac Life Support, arterial pH and presence of seizure. CONCLUSION: The elderly have worse neurological outcome and survival rate post resuscitation. Factors associated with survival were mainly related to low flow during cardiac arrest. However, there was no significant influence from complications during TH on survival. Thus, TH can be administered safely to elderly patients for successful resuscitation after cardiac arrest. Further study on the effects of TH in the elderly should be done.
Advanced Cardiac Life Support ; Aged ; APACHE ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Hypothermia ; Korea ; Lactic Acid ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Seizures ; Survival Rate

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Fluoroscopic Swallowing Study in Elderly Patients Admitted to a Geriatric Hospital and a Long-Term Care Facility.

Sang Jun KIM ; Tai Ryoon HAN

Journal of the Korean Geriatrics Society.2009;13(4):195-202. doi:10.4235/jkgs.2009.13.4.195

BACKGROUND: No study has been done to detect the aspiration using the videofluoroscopic swallowing study in the elderly patients. Elderly patients admitted to hospitals or long-term care facilities may intake the food orally without any evaluation of swallowing function and may be exposed to aspiration risk, which can be eliminated by some diet modification based on the fluoroscopic findings. METHODS: Sixty-three elderly patients who had an oral-feeding status were recruited in this study. They swallowed diverse food textures twice in the following order; liquid, Yoplait yogurt, pudding, soft-bland diet, and a regular diet. Swallowing parameters were checked as subglottic aspiration, supraglottic penetration, delayed pharyngeal reflex, and vallecular and pyriform sinus residues. RESULTS: Only 2 patients showed both aspiration signs and the subglottic aspiration in the fluoroscopic study. Six patients showed the subglottic aspiration in the fluoroscopic study without any clinical sign. Seven patients who complained of aspiration signs did not show the subglottic aspiration, but all of them presented the supraglottic penetration. Multivariate logistic regression analysis showed that no covariate was correlated with the subglottic aspiration whereas delayed pharyngeal reflex during liquid (p<0.001) or Yoplait (p=0.010) swallowing were correlated with aspiration plus penetration. CONCLUSION: This study demonstrates that a fluoroscopic swallowing study is important for the dysphagia diagnosis in elderly patients because of no significant correlation between the aspiration signs assessed clinically and the subglottic aspiration detected by the fluoroscopic swallowing study. Diet modifications, such as, liquid thickening will be necessary when patients demonstrate the evidence of subglottic aspiration during swallowing.
Aged ; Deglutition ; Deglutition Disorders ; Diet ; Fluoroscopy ; Food Habits ; Gagging ; Geriatrics ; Humans ; Logistic Models ; Long-Term Care ; Pyriform Sinus ; Yogurt

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Suggestions for Improving Doctor's Opinion for the National Long-term Care Insurance.

Chang Won WON ; Ji Young KIM ; Il Man JEONG

Journal of the Korean Geriatrics Society.2009;13(4):181-194.

Applicants for care services offered by the National Long-term Care Insurance are required to submit a written docu- ment of assessments performed by a physician.These documents are used as a secondary source to determine the level of long-term care required by the applicant. Though necessary, physicians have not received evaluation or fee-dback regarding this process. We surveyed doctors, members of committees for long-term care level assessment, and long-term care team staff of the national health insurance corporation. What was considered useful information differed among the three groups. Integrating the feedback from these groups, we suggested improvements that could be made to this assessment process.
Insurance ; Insurance, Long-Term Care ; Long-Term Care ; National Health Programs

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Hepatic Portal Venous Gas.

Sung Yeun YANG ; Young Jin LEE ; Sang Youl PARK ; Tae Hee KIM ; Hyun Kuk KIM ; Soo Kyoung KWON ; Ji Hwa RHYU

Journal of the Korean Geriatrics Society.2010;14(1):48-52. doi:10.4235/jkgs.2010.14.1.48

Hepatic portal venous gas (HPVG) is a rare disease presenting as acute abdomen. There were first described in children with necrotizing enterocolitis in 1955. HPVG is caused by mesenteric ischemia but may have various etiologies. Predisposing factors that develop mesenteric ischemia include gastric ulcer disease, bowel obstruction, diverticulitis and sepsis. The presence of the air in the portal and mesenteric vein on radiographics has been associated with a mortality rate of more than 75% in earlier studies. Abdominal computed tomography has proven useful for detecting portomesenteric venous gas and pneumatosis intestinalis. We report a case of the patient with hepatic portal venous gas with pneumatosis intestinalis, which showed rapid progress of the disease and eventually died within 24 hours of admission.
Abdomen, Acute ; Child ; Diverticulitis ; Enterocolitis, Necrotizing ; Humans ; Ischemia ; Mesenteric Veins ; Portal Vein ; Rare Diseases ; Sepsis ; Stomach Ulcer

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A Case of Pseudomembranous Aspergillus Tracheobronchitis in a Patient with Diabetes Mellitus.

Young Arm YI ; Jong Min KIM ; Se Jin HWANG ; Shi Jung SUNG ; Se Jin KIM ; Young Min KIM ; Kwang Won SEO ; Seung Won RA ; Yangjin JEGAL

Journal of the Korean Geriatrics Society.2010;14(1):42-47. doi:10.4235/jkgs.2010.14.1.42

Aspergillus tracheobronchitis is one form of invasive pulmonary aspergillosis which is characterized by ulcers and pseudomembrane formation in tracheobronchial tree. In Aspergillus tracheobronchitis, the infection is often limited to the mucosa and it accounts for less than 10 percents of invasive disease. Invasive aspergillosis mainly occurs in immunocompromized patients with prolonged neutropenia, advanced AIDS, organ transplantation, high-dose glucocorticoid therapy or cytotoxic therapy although it can occur in less immunocompromised patients, such as after influenza, COPD, old age, and diabetes. We report a case of Aspergillus tracheobronchitis in a 61 year-old patient with diabetes and Child Pugh class A liver cirrhosis. He presented with cough and purulent sputum for 10 days. He was diagnosed by bronchoscopy and successfully treated with antifungal therapy.
Aspergillosis ; Aspergillus ; Bronchitis ; Bronchoscopy ; Child ; Cough ; Diabetes Mellitus ; Humans ; Immunocompromised Host ; Influenza, Human ; Invasive Pulmonary Aspergillosis ; Liver Cirrhosis ; Mucous Membrane ; Neutropenia ; Organ Transplantation ; Pulmonary Disease, Chronic Obstructive ; Sputum ; Transplants ; Ulcer

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A Case of Synchronous Double Early Gastric Cancer Lasting for 10 Years in Elderly Patient.

Pyung Gohn GOH ; Hee Seok MOON

Journal of the Korean Geriatrics Society.2010;14(1):36-41. doi:10.4235/jkgs.2010.14.1.36

Early gastric cancer (EGC), which is defined as a lesion confined to the mucosa or the submucosa, regardless of the presence of lymph node metastasis, has a good prognosis than advanced gastric cancer. Generally, untreated early gastric cancer progress to advanced cancer cancer (AGC). But natural history of EGC is unclear and different from AGC. For example, EGC can have long natural history and frequently multiple synchronous lesions than AGC. And rarely, EGC can last as EGC for several years. This is the case lasting synchronous double EGC for 10 years in the elderly patient.
Aged ; Humans ; Lymph Nodes ; Mucous Membrane ; Natural History ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms

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The Association Between Frequency of Food Group Consumption and Functional Disability in Older People.

Jinhee KIM ; Yunhwan LEE ; Joung Hwan BACK

Journal of the Korean Geriatrics Society.2010;14(1):25-35. doi:10.4235/jkgs.2010.14.1.25

BACKGROUND: We evaluated the association between the frequency of food group consumption and functional disability in Korean older people. METHODS: Data are from the 2005 Korea National Health and Nutrition Examination Survey. Subjects were 771 people (324 men and 447 women) aged 65 and older living in the community. Information on frequency of food group consumption was obtained using a food-frequency questionnaire and functional disability was assessed using the activities of daily living (ADL) and instrumental ADL (IADL) scales. Multiple logistic regression analyses were used to examine the association of frequency of food group consumption with ADL and IADL. RESULTS: Adjusting for covariates, in men, frequency of milk and their products consumption was inversely associated with IADL disability [OR (95% CI): 0.29 (0.13-0.65); p for trend=0.003]. Frequencies of fish and shellfish, and beverages consumption were also inversely associated with IADL disability. In women, frequencies of vegetables, seaweeds, and beverages consumption were inversely associated with ADL disability. Frequency of legumes and their products consumption was inversely associated with IADL disability [OR (95% CI): 0.56 (0.33-0.95); p for trend=0.063]. CONCLUSION: Increased frequencies of food group consumption may be protective against functional disability in Korean older people. Further research is needed to ascertain the effect of diet on physical disability in older persons.
Activities of Daily Living ; Aged ; Beverages ; Diet ; Disability Evaluation ; Fabaceae ; Female ; Humans ; Korea ; Logistic Models ; Male ; Milk ; Nutrition Surveys ; Surveys and Questionnaires ; Shellfish ; Vegetables ; Weights and Measures

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Pneumococcal Vaccination Rate among Elderly in South Korea.

Juwon LIM ; Chun Sick EOM ; Soyeun KIM ; Soshin KE ; Belong CHO

Journal of the Korean Geriatrics Society.2010;14(1):18-24. doi:10.4235/jkgs.2010.14.1.18

BACKGROUND: Pneumococcal vaccination among elderly is important for prevention of pneumonia and invasive pneumococcal disease (IPD). There are few studies of pneumococcal vaccination among elderly in South Korea. The aim of study is to examine the pneumococcal vaccination rate for people aged over 65 in South Korea and identify the proportion of the high risk group. METHODS: We analyzed data from The Third Korea National Health and Nutrition Examination Survey (KNHANES III) 2005. The subjects of this study include persons over 65 years. We used questionnaires about demographics, chronic diseases and individual health behavioral risk factors, which were needed to indentify the high risk group. RESULTS: There were 1,097 persons of observation. The rate of pneumococcal vaccination among 65 years and over was 0.8%. The proportion of the men and women with one more risk factors was 77.3%, 62.8% respectively. Chronic cardiovascular diseases and diabetes were major risk factors among targets recommended vaccination. In men, the proportion of smoke and chronic alcoholism (33.2%, 12.3%) was higher compare to 7.4%, 0.3% in women (p<0.001, p<0.001). The proportion of chronic cardiovascular diseases (48.0%) in women was higher than (38.7%) in men (p=0.012). CONCLUSION: The rate of pneumococcal vaccination among elderly in South Korea was seriously very low compared to that of influenza vaccination. That might be due to unawareness of the necessity to vaccinate. Clinicians should encourage the vaccination as well take a leading role in government health policy
Aged ; Alcoholism ; Cardiovascular Diseases ; Chronic Disease ; Demography ; Female ; Health Behavior ; Health Policy ; Humans ; Influenza, Human ; Korea ; Male ; Nutrition Surveys ; Pneumococcal Infections ; Pneumococcal Vaccines ; Pneumonia ; Surveys and Questionnaires ; Republic of Korea ; Risk Factors ; Smoke ; Vaccination

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Falls in a Proportional Region Population in Korean Elderly: Incidence, Consequences, and Risk Factors.

Jae Young LIM ; Won Beom PARK ; Min Kyun OH ; Eun Kyoung KANG ; Nam Jong PAIK

Journal of the Korean Geriatrics Society.2010;14(1):8-17. doi:10.4235/jkgs.2010.14.1.8

BACKGROUND: To investigate the occurrence of falls and their consequences in a representative population and to identify risk factors of falls in the elderly. METHODS: The study participants were community-dwelling elderly people aged 65 years or old as a population based sample of one large city. A total of 828 people 65 years or older participated in this study. They were interviewed over the telephone by a trained interviewer using a structured questionnaire to obtain a fall history and details of their most recent fall including date, time, place, circumstances, and associated injury. As for risk factors for falls, we asked about living arrangement (with family or alone), alcohol intake, exercise, visual and hearing impairments, memory and sensory problems, lower limb weakness, and arthritis symptoms. Fear of falling and fear-related activity restriction were also evaluated. RESULTS: The incidence of falls during the last one year was 13.0%. Women experienced falls more frequently. Falls occurred mainly in spring and summer and from 10 AM to 3 PM. Common causes of falls were slipping and tripping. 14.9% of those who fell suffered consequent fractures. Being female was a significant risk factor for falls; and females tended to get injured more severely following a fall. During the recent one year, decreased proprioception in the lower extremity was a significant risk factor for falls. Those with histories of falls, and especially women, tended to limit their activities due to the fear of falling. CONCLUSION: Overall, it appears that elderly women are more greatly affected by falls at several levels. Female participants fell more frequently and suffered more severe consequences. Fall-related injuries and risk factors for falls disproportionately affected women. And, being female and any amount of decreased sensation in the feet were significant risk factors for falls.
Aged ; Arthritis ; Female ; Foot ; Hearing ; Humans ; Hypogonadism ; Incidence ; Lower Extremity ; Memory ; Mitochondrial Diseases ; Ophthalmoplegia ; Proprioception ; Surveys and Questionnaires ; Residence Characteristics ; Risk Factors ; Sensation ; Telephone

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Frailty: A Core Geriatric Concept.

Kwang Il KIM

Journal of the Korean Geriatrics Society.2010;14(1):1-7. doi:10.4235/jkgs.2010.14.1.1

Frailty, a progressive physiologic decline in multiple body systems, is defined as a state of increased vulnerability to the stress that carries an increased risk of disability, hospitalization, functional decline, and mortality in older adults. Frailty is a new and emerging syndrome in the field of geriatrics. With the advance of population aging, frail elderly continue to increase and frail older adults are among the most challenging for medical management. Contrary to popular belief, frailty is not present in all elderly persons, which suggests that it is associated with aging but not an inevitable process of aging and may be prevented or treated. Common signs and symptoms of frailty are fatigue, weight loss, muscle weakness, slowness, and low activity. The purpose of this article is to review what is known about frailty, including the definition, epidemiology, pathophysiology, and to examine potential areas of future research.
Adult ; Aged ; Aging ; Fatigue ; Frail Elderly ; Geriatrics ; Hospitalization ; Humans ; Muscle Weakness ; Weight Loss

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