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The Effectiveness of Lean Body Mass Analysis Using Dual Energy X-ray Absorptiometry for Diagnosis of Sarcopenia: Systematic Review.

So Young KIM ; Sun Young PARK

Journal of the Korean Geriatrics Society.2016;20(2):78-84. doi:10.4235/jkgs.2016.20.2.78

BACKGROUND: This study aimed to evaluate the effectiveness of lean body mass analysis using dual-energy X-ray absorptiometry (DEXA) for diagnosing sarcopenia. METHODS: We conducted a systematic review by searching eight Korean databases and international databases, including Ovid-MEDLINE, Embase, and Cochrane Library. Twenty-five studies using DEXA were included in the final assessment. Two reviewers independently assessed the quality of the included studies and extracted data. The quality of the studies was assessed according to the Scottish Intercollegiate Guidelines Network tool. RESULTS: The effectiveness of lean body mass analysis using DEXA was assessed by means of correlations with comparators, relevance to clinical symptoms, and forecasting of prognosis. The correlations with comparators (magnetic resonance imaging, computed tomography, bioelectrical impedance analysis, and anthropometry) took different positions. The risk ratio (RR) or odds ratio (OR) of the decrease in physical functions was 0.57-2.48, and the RR of osteoporosis was 1.15-9.4. The hazard ratio of death was 1.24-3.12, OR of cardiovascular disease was 1.768, and RR of survival was 0.85. CONCLUSION: Lean body mass analysis using DEXA for diagnosing sarcopenia seems promising, but more studies are needed to clarify the diagnostic criteria for sarcopenia and cut-off for DEXA.
Absorptiometry, Photon* ; Cardiovascular Diseases ; Diagnosis* ; Electric Impedance ; Forecasting ; Odds Ratio ; Osteoporosis ; Prognosis ; Sarcopenia*

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Association Between Geriatric Nutritional Risk Index and Prolonged Length of Stay After Elective Hepatectomy in the Elderly Patients.

Hyun Ju LIM ; Dong Wook JEONG ; Sang Yeoup LEE ; Young Hye CHO ; Yun Jin KIM ; Jeong Gyu LEE ; Yu Hyeon YI ; Young Jin TAK ; Sang Yun KANG ; Chong Woo CHU ; Je Ho RYU

Journal of the Korean Geriatrics Society.2016;20(2):71-77. doi:10.4235/jkgs.2016.20.2.71

BACKGROUND: Malnutrition is common in elderly patients with cancer and is associated with many adverse clinical outcomes, including longer length of hospital stay (LOS), muscle loss, and various postsurgical complications. In particular, elderly patients with hepatocellular carcinoma have a high risk for malnutrition, which is associated with mortality and reduced quality of life. Therefore, we evaluated the association between nutritional status and the LOS after hepatectomy for the treatment of hepatocellular carcinoma in elderly patients. METHODS: A retrospective study was conducted on 66 patients aged ≥65 years admitted consecutively from January 2010 to December 2014 for elective surgery to treat hepatocellular carcinoma. The Geriatric Nutritional Risk Index (GNRI) was applied for the assessment of nutritional risk in hospitalized elderly patients before surgery. RESULTS: The association between several factors that have been identified to influence outcomes and the LOS were evaluated by using multiple regression analysis. We found that only the GNRI was associated with the LOS. CONCLUSION: Our study shows that identifying nutritional risk using the GNRI before elective surgery is associated with increased risk of prolonged LOS. Therefore, prospective research based on GNRI can serve as a valuable resource for evaluating nutritional status of elderly patients under various clinical circumstances. Moreover, this particular research allows us to establish new ways of reducing the length of hospital stay for patients who underwent hepatic resection.
Aged* ; Carcinoma, Hepatocellular ; Hepatectomy* ; Humans ; Length of Stay* ; Malnutrition ; Mortality ; Nutrition Assessment ; Nutritional Status ; Prospective Studies ; Quality of Life ; Retrospective Studies

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The Current Status of End-of-Life Care in Korea and Legislation of Well-Dying Act.

Ji Eun LEE ; Ae Jin GOO ; Be Long CHO

Journal of the Korean Geriatrics Society.2016;20(2):65-70. doi:10.4235/jkgs.2016.20.2.65

Recently, the Well-dying Act was legislated in Korea, and it will come into force in 2018. The rapid aging of this society has made many older patients and their families suffer from pain and disability for a long time towards the end of life. Hospice care, when compared to life-sustaining treatment, can relieve such burdens. Regarding the decision of choosing hospice care at the end of life, advance care planning and advance directives can help people express their preference beforehand. In Korea, hospice care is still not actively used and most patients endure life-sustaining treatment until death. Many patients want hospice care, but there has not been a legal basis for such a decision, leading to social conflict and many legal problems. The Well-dying Act will provide a legal basis for such a decision. This will help establish and promote hospice care in Korea. However, sufficient discussion and preparation are required before enforcing the Act.
Advance Care Planning ; Advance Directives ; Aging ; Hospice Care ; Humans ; Korea*

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Gallstone Ileus in 83-Year-Old Woman.

Song Hee OH ; Jun Ho JO ; Il Soo KIM ; Woo Young KIM ; Kun Woo PARK ; Min Woong JUNG ; Jong Ik PARK ; Se Ryeong PARK

Journal of the Korean Geriatrics Society.2014;18(4):246-250. doi:10.4235/jkgs.2014.18.4.246

Gallstone ileus is a rare complication of the biliary stone, occurring in 0.3-0.5% of patients with cholelithiasis. The mortality rate is high at 12-27% and early diagnosis and prompt management can improve its prognosis. An 83-year-old woman was admitted to the hospital with abdominal pain. The patient previously had a hysterectomy and had received radiation therapy for uterine cancer. Plain abdominal x-ray showed typical findings of small bowel ileus with step ladder patterns. Computed tomography (CT) scan revealed biliary-enteric fistula with a 3-cm-sized gallstone in the jejunal loop. Surgical treatment was planned but due to the patient's wish, conservative treatment was provided for 10 days. In the follow-up CT scan, the stone had moved to the distal ileum but intestinal perforation was suspected. Ileocecectomy and adhesiolysis were performed and the patient recovered fully. Here we report a case of gallstone ileus that was treated by surgical removal after 10 days of conservative treatment.
Abdominal Pain ; Aged, 80 and over* ; Cholelithiasis ; Early Diagnosis ; Female ; Fistula ; Follow-Up Studies ; Gallstones* ; Humans ; Hysterectomy ; Ileum ; Ileus* ; Intestinal Perforation ; Mortality ; Prognosis ; Tomography, X-Ray Computed ; Uterine Neoplasms

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Strongyloides Hyperinfection in an Elderly Patient Treated for Stomach Cancer.

Young Min RAH ; Su A YUN ; Hee Jung YOON ; Seung Yun LEE

Journal of the Korean Geriatrics Society.2014;18(4):241-245. doi:10.4235/jkgs.2014.18.4.241

Strongyloides stercoralis is an intestinal nematode with a complex life cycle, including a free living cycle, a parasitic cycle, and an auto-infection cycle. S. stercolaris infection may occur in both immunocompetent and immunocompromised individuals. It is usually asymptomatic and undetectable for decades in a healthy host. In immunocompromised patient, however, it may cause life threatening hyperinfection involving multiple organs. In Korea, several cases of Strongyloides hyperinfection have been reported since 1959. However, reports with gastric involvement and peritoneal invasion are rare. This is a report of gastric strongyloidiasis hyperinfection identified at ascites in an elderly patient who had subtotal gastrectomy due to stomach cancer.
Aged* ; Ascites ; Gastrectomy ; Humans ; Immunocompromised Host ; Ivermectin ; Korea ; Life Cycle Stages ; Parasitology ; Stomach Neoplasms* ; Strongyloides stercoralis ; Strongyloides* ; Strongyloidiasis

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Perforation of Gastrointestinal Stromal Tumor in Small Bowel on an Elderly Patient Presenting Acute Abdominal Pain.

Kong Jin OH ; Jong Ho HWANG ; Ho Young LEE ; Sung Ik PYEON ; Jae Gyu SHIN ; Ho Joon PARK ; Chul Byung CHAE

Journal of the Korean Geriatrics Society.2014;18(4):237-240. doi:10.4235/jkgs.2014.18.4.237

Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.
Abdominal Pain* ; Aged* ; Aged, 80 and over ; Diagnosis ; Emergency Service, Hospital ; Gastrointestinal Stromal Tumors* ; Hand ; Humans ; Immunohistochemistry ; Jejunum ; Laparotomy ; Mortality

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Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide.

Chang Kyoo BYON ; Sang Woo YIM ; Jun Yong PARK ; Mee Sook ROH ; Sung Won LEE ; Won Tae CHUNG ; Sang Yeob LEE

Journal of the Korean Geriatrics Society.2014;18(4):232-236. doi:10.4235/jkgs.2014.18.4.232

Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.
Abdominal Pain ; Aged ; Arthritis, Rheumatoid* ; Biopsy, Needle ; Cryptococcosis* ; Diarrhea ; Dyspepsia ; Exanthema ; Female ; Humans ; Hydroxychloroquine ; Hypertension ; Korea ; Lung ; Lung Diseases, Interstitial ; Methenamine ; Methotrexate ; Nausea ; Oral Ulcer ; Radiography, Thoracic ; Solitary Pulmonary Nodule ; Sulfasalazine ; Treatment Failure ; Weight Loss

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The Relationship of Long-term Care Workers' Health Awareness on Life Satisfaction.

Jung Gyu PARK ; Hyun Soon PARK

Journal of the Korean Geriatrics Society.2014;18(4):221-231. doi:10.4235/jkgs.2014.18.4.221

BACKGROUND: Considering the importance of human resource management of the long-term care workers, this study is to propose a political and practical intervention approach. The approach is based on the analysis of research on the influe nce of long-term care workers' health awareness on their life satisfaction. METHODS: The participants of this study include 600 long-term care workers working at Nursing homes and Nursing facilities located in Seoul. The data collected from the participants are analyzed with Multi Regression Analysis. RESULTS: The participants of this study include 600 long-term care workers working at Nursing homes and Nursing facilities located in Seoul. The data collected from the participants are analyzed with Multi Regression Analysis. Results: As a result of T-test and analysis of variance, statistically significant parameters to the subjective awareness of health are as follows: marriage, education, religion and work places. And as the minor parameters that influence the rate of life satisfaction the positive relationships between the emotional health (beta=0.178, p<0.01) and the intellectual health (beta=0.281, p<0.001) is statistically significant. CONCLUSION: The results of analysis indicate as follows: there is a positively significant relationship between social demographic characteristics, health awareness and life satisfaction; the higher participation in social activities, more women than men, and the higher income, the higher health awareness. The findings point out the importance of emotional and intellectual health and efforts to promote better health and demand for a societal change in health awareness. This study provides the baseline data for a practical intervention measure and political suggestion by examining how the individual characteristics and health awareness influence life satisfaction of long-term care workers, and by analyzing the effect of the interactions between them.
Education ; Female ; Humans ; Long-Term Care* ; Male ; Marriage ; Nursing ; Nursing Homes ; Seoul ; Workplace

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Comprehensive Geriatric Assessment for Elderly Orthopedic Inpatients Consulted by Geriatric Medicine in a Hospital.

Go Eun KIM ; Sunyoung KIM ; Chang Won WON ; Hyun Rim CHOI ; Byung Sung KIM ; Yoon Je CHO

Journal of the Korean Geriatrics Society.2014;18(4):213-220. doi:10.4235/jkgs.2014.18.4.213

BACKGROUND: With a rapidly aging population, more elderly patients are being hospitalized than before. Thus, a comprehensive geriatric assessment medium is needed to carefully evaluate geriatric patients. The author's university hospital has a geriatric medicine team to where patients are referred for comprehensive evaluations. Their services will be introduced here. METHODS: From December 2010 to January 2012, the team performed comprehensive geriatric assessments comprising of a thorough review of systems, physical examination, and surveys, and reviewed past medical records of the elderly hospitalized patients aged 65 or over, referred from the Department of Orthopedics. RESULTS: Of total 58 patients, 4 patients (6.9%) had severe dysfunction in the activities of daily living with the score of 16 or higher. Twenty-two patients (73.3%) had cognitive impairment or dementia upon assessing cognitive function after excluding those previously diagnosed with dementia or those within 5 days after surgery, thus predisposed to delirium who had tested mini mental state examination for cognitive function level test. Fifteen patients (31.3%) had mild depression, while four (8.3%) had moderate depression; and 37 patients (67.3%) were at moderate risk and five (9.1%) were at high risk for developing delirium. CONCLUSION: A comprehensive evaluation of the functional status of elderly hospitalized patients was helpful in detecting medical problems other than the initial diagnosis. A significant proportion of the elderly patients we assessed were suspected to have cognitive impairment.
Activities of Daily Living ; Aged* ; Aging ; Delirium ; Dementia ; Depression ; Diagnosis ; Geriatric Assessment* ; Humans ; Inpatients* ; Medical Records ; Orthopedics* ; Physical Examination

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Diagnostic Characteristics of Geriatric Patients With Ureterolithiasis in Emergency Center.

Hyun Suk SIM ; Han Sung CHOI ; Jong Seok LEE ; Hoon Pyo HONG ; Young Gwan KO

Journal of the Korean Geriatrics Society.2014;18(4):205-212. doi:10.4235/jkgs.2014.18.4.205

BACKGROUND: Incidence rate of ureterolithiasis has been increasing worldwide in general, with an especially rapid increase in the elderly, over 65 years of age. Therefore, the characteristics of geriatric patients diagnosed with uureterolithiasis in an Emergency Center were examined. METHODS: A total of 613 consecutive patients who were diagnosed with ureterolithiasis through computed tomography from January 2012 to March 2014 were analyzed retrospectively. The patients were divided in two groups: the geriatric group and nongeriatric group. RESULTS: Among the 613 patients, there were 64 geriatric patients (> or =65 years, 10.4%) and 549 nongeriatric patients (<65 years, 89.6%). In the geriatric patients, 13 patients (20.3%) appeared without any pain or with atypical types of pain, while 39 of the nongeriatric patients (7.1%) had no pain or atypical symptoms, presenting a statistically significant difference (p<0.001). Gastrointestinal symptoms such as nausea and vomiting were more common in geriatric patients than in nongeriatric patients (42.2% vs. 29.9%, p=0.044), while lower positive rate of microscopic hematuria was reported (78.1% vs. 90.5%, p=0.002). Furthermore, in geriatric patients, the positive rate of costovertebral angle tenderness was lower and distal ureter stones were found to be more common, while urine pH and serum creatinine levels were higher. CONCLUSION: In comparison to nongeriatric patients, geriatric patients with ureterolithiasis showed lower rates of renal colic and hematuria, while showing higher rates of having gastrointestinal symptoms such as nausea and vomiting. Thus, differences between these two groups should be considered in evaluating geriatric patients to prevent complications which may be caused from the late diagnosis of ureterolithiasis.
Aged ; Creatinine ; Delayed Diagnosis ; Emergencies* ; Geriatrics ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Nausea ; Renal Colic ; Retrospective Studies ; Ureter ; Ureterolithiasis* ; Vomiting

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