Abstract Pituitary adenomas are common intracranial tumors that can be classified based on their hormonal activity and size. While microadenomas are more frequent, macroadenomas often present with significant clinical manifestations due to hormone excess or mass effects. In older populations, diagnosis is often delayed as physical changes may be subtly attributed to normal aging. A 61-year-old woman presented with progressively coarsening facial features and enlargement of the hands and feet. Physical examination confirmed acral enlargement, and the patient reported persistent headaches and a history of hypertension. Laboratory investigations revealed significantly elevated levels of growth hormone (GH) at 18.9 ng/mL and insulin-like growth factor-1 (IGF-1) at 865.6 ng/mL. Other pituitary functions, including prolactin and morning cortisol, were within normal limits. Magnetic resonance imaging (MRI) identified a 1.3 × 2.5 × 1.0 cm pituitary macroadenoma. The patient subsequently underwent successful endonasal endoscopic transsphenoidal surgery for tumor resection. This case underscores the necessity of maintaining a high index of suspicion for acromegaly in elderly patients presenting with unexplained acral and facial changes. Comprehensive endocrine evaluation and advanced imaging are critical for achieving an accurate diagnosis and ensuring timely surgical intervention to prevent disease progression.
Acromegaly ; Pituitary Macroadenoma ; Growth Hormone ; IGF-1 ; Transsphenoidal Surgery ; Endocrinology ; Elderly Care

OBJECTIVES: To address and elucidate the impact of pharmacist-led home medicines review (HMR) services on identifying drug-related problems (DRPs) among the elderly population in home care settings.METHODS: A comprehensive systematic search was performed using electronic scientific databases such as PubMed, Scopus, Embase, and Web of Science for studies published between January 1, 2008 and December 31, 2018, pertaining to HMR services by pharmacists for identifying DRPs.RESULTS: In total, 4,292 studies were retrieved from the searches, of which 24 were excluded as duplicates. Titles and abstracts were screened for the remaining 4,268 studies, of which 4,239 were excluded due to the extraneous nature of the titles and/or abstracts. Subsequently, 29 full-text articles were assessed, and 19 were removed for lacking the outcome of interest and/or not satisfying the study's inclusion criteria. Finally, 10 studies were included in the review; however, publication bias was not assessed, which is a limitation of this study. In all studies, pharmacists identified a highly significant amount of DRPs through HMR services. The most common types of DRPs were potential drug-drug interactions, serious adverse drug reactions, need for an additional drug, inappropriate medication use, non-adherence, untreated indications, excessive doses, and usage of expired medications.CONCLUSIONS: HMR is a novel extended role played by pharmacists. The efficiency of such programs in identifying and resolving DRPs could minimize patients' health-related costs and burden, thereby enhancing the quality of life and well-being among the elderly.
Aged ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Frail Elderly ; Home Care Services ; Humans ; Pharmacists ; Publication Bias ; Quality of Life

OBJECTIVES: To address and elucidate the impact of pharmacist-led home medicines review (HMR) services on identifying drug-related problems (DRPs) among the elderly population in home care settings. METHODS: A comprehensive systematic search was performed using electronic scientific databases such as PubMed, Scopus, Embase, and Web of Science for studies published between January 1, 2008 and December 31, 2018, pertaining to HMR services by pharmacists for identifying DRPs. RESULTS: In total, 4,292 studies were retrieved from the searches, of which 24 were excluded as duplicates. Titles and abstracts were screened for the remaining 4,268 studies, of which 4,239 were excluded due to the extraneous nature of the titles and/or abstracts. Subsequently, 29 full-text articles were assessed, and 19 were removed for lacking the outcome of interest and/or not satisfying the study’s inclusion criteria. Finally, 10 studies were included in the review; however, publication bias was not assessed, which is a limitation of this study. In all studies, pharmacists identified a highly significant amount of DRPs through HMR services. The most common types of DRPs were potential drug-drug interactions, serious adverse drug reactions, need for an additional drug, inappropriate medication use, non-adherence, untreated indications, excessive doses, and usage of expired medications. CONCLUSIONS: HMR is a novel extended role played by pharmacists. The efficiency of such programs in identifying and resolving DRPs could minimize patients’ health-related costs and burden, thereby enhancing the quality of life and well-being among the elderly.
Aged ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Frail Elderly ; Home Care Services ; Humans ; Pharmacists ; Publication Bias ; Quality of Life

Frailty is a distinct clinical syndrome wherein the individual has low reserves and is highly vulnerable to internal and external stressors. Although it is associated with disability and multiple comorbidities, it can also be present in individuals who seem healthy. Frailty is multidimensional and its pathophysiology is complex. Early identification and intervention can potentially decrease or reverse frailty, especially in the early stages. Primary care physicians, community nurses and community social networks have important roles in the identification of pre-frail and frail elderly through the use of simple frailty screening tools and rapid geriatric assessments. Appropriate interventions that can be initiated in a primary care setting include a targeted medical review for reversible medical causes of frailty, medication appropriateness, nutritional advice and exercise prescription. With ongoing training and education, the multidisciplinary engagement and coordination of care of the elderly in the community can help to build resilience and combat frailty in our rapidly ageing society.
Aged ; Aging ; Community Health Services ; Frail Elderly ; Frailty ; Geriatric Assessment ; methods ; Geriatrics ; methods ; Humans ; Nurses ; Nursing ; Primary Health Care ; methods ; Social Support

BACKGROUND: Slow-motion training, an exercise marked by extremely slow movements, yields a training effect like that of a highly intense training, even when the applied load is small. This study evaluated the effects of low-intensity bodyweight training with slow movement on motor function in frail, elderly patients. METHODS: Ninety-seven elderly men and women aged 65 years or older, whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care level 1 and 2), volunteered to participate. Two facilities were used. Participants in the first facility used low-intensity bodyweight training with slow movement (the LST group, n = 65), and participants in another facility used machine training (the control group, n = 31). Exercises were conducted for 3 months, once or twice a week, depending on the required level of nursing care. Changes in motor function were examined. RESULTS: Post-exercise measurements showed significant improvements from the pre-exercise levels after 3 months, based on the results of the Timed Up and Go test (p = 0.0263) and chair-stand test (p = 0.0016) in the low-intensity exercise with slow movement and tonic force generation (LST) group. Although the ability to stand on one leg with eyes open tended to improve, no significant change was found (p = 0.0964). CONCLUSIONS: We confirmed that carrying out LST bodyweight training for 3 months led to improvements in ambulatory function and lower-limb muscle strength. In this way, it is possible that LST training performed by holding a bar or by staying seated on a chair contributes to improved motor function in elderly patients within a short time. TRIAL REGISTRATION UMIN000030853 . Registered 17 January 2018. (retrospectively registered).
Aged ; Aged, 80 and over ; Female ; Frail Elderly ; Humans ; Long-Term Care ; Male ; Motor Activity ; Movement ; Prospective Studies ; Resistance Training ; methods

Thailand’s growing aging population who have increased longevity has resulted in an upsurge in disability and the expectation of chronic diseases. The demand for increased care challenges the government to develop treatment and long-term management procedures. This study explores the following two objectives: 1) identifying policies for intervention that improve the quality of life of the elderly; and 2) developing a sustainable and feasible ten-year delivery system for Long Term Care (LTC). We conducted comprehensive interviews with 8 male and 3 female policy makers on LTC development for the elderly in Thailand and analyzed these transcripts by using NVivo 8 data analysis. Two independent investigations that contain thematic codes have been developed from the transcript subset’s first set. Six of the identified issues – care services imbalance, poor management, skill search, health workforce scarcity, regulations, and information system problems – are considered urgent and require a solution. The surveys reiterate that an LTC scheme will become family- and community-based in a decade. The improvements in the quality of life for elderly patients with long-term conditions are accomplished through integrated services, regulatory system consolidation, an LTC workforce, infrastructure delivery, and investment in elderly health groups. LTC must use an all-inclusive societal policy.
Community ; Elderly ; Financing ; In-depth interview ; Long Term Care ; Policy maker ; Thailand

With the rapid increase in the number of Korean older adults, developing and integrating quality, expert older adult care in the Korean health care system will be essential and a tremendous benefit to these older adult patients, their families, and Korean society. While the awareness of geriatric medicine as a specialty for physicians caring exclusively for older adults has improved greatly in recent decades among Korean health care providers and older adult patients, there is still great opportunity to improve training opportunities for all medical students, primary care physicians, and specialty Geriatrics. Korea must also formally establish uniform geriatric medicine fellowships and certification. However, a number of barriers such as insufficient expertise, low incentives, and competitive geriatric societies exist to implement widespread, quality geriatric medicine in the Korean health care system.
Adult ; Aged ; Certification ; Clothing ; Delivery of Health Care ; Fellowships and Scholarships ; Frail Elderly ; Geriatrics ; Health Personnel ; Humans ; Korea* ; Motivation ; Physicians, Primary Care ; Students, Medical ; United States*

The geriatric surgical population experiences greater morbidity and mortality than the general surgical population. Understanding the characteristics of postoperative complications in elderly patients and carrying out adequate preventive measures and treatments are the best way to reduce postoperative complications in the geriatric surgical population. The proportion of the geriatric population has gradually increased in the Republic of Korea, and this is a worldwide trend. The postoperative care of elderly patients has drawn particular attention given the increasing interest in geriatric medicine. We introduce several postoperative complications that are closely associated with the elderly surgical population and the possible etiology of these complications, and discuss the differences between the general patient population and elderly patients.
Aged ; Frail Elderly ; Humans ; Mortality ; Postoperative Care* ; Postoperative Complications ; Republic of Korea

PURPOSE: The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS: The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS: With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION: This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.
Accidental Falls* ; Aged* ; Extremities ; Frail Elderly ; Gait ; Home Care Services* ; Humans ; Incidence ; Lower Extremity ; Muscle Strength* ; Risk Factors ; Walking*

BACKGROUND: Home health-care services have been implemented to promote health among older adults (medicare beneficiaries and low-income or vulnerable older adults) with health conditions, though there is limited evidence to support their effectiveness. This study aimed to identify improvements in frailty and depression in vulnerable older adults who received home health-care services. METHODS: We used a database comprised of approximately 15,053 older adults residing in the Seoul metropolitan area having received home health-care services from 2008 to 2011. Frailty was measured using the Otasha-Kenshin scale, and geriatric depression was measured using the short-form Geriatric Depression Scale. RESULTS: We observed a significant decline in the prevalence of frailty and depression symptoms in vulnerable older adults between 2009 and 2011 (p<0.001). Logistic regression analysis found that the decreased prevalence observed in vulnerable older adults was statistically significant for both frailty (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.43-0.63; p<0.001) and depression (OR, 0.61; 95% CI, 0.51-0.72; p<0.001). A greater decrease was observed among the younger elderly subjects. CONCLUSION: This study showed that frailty and depression were significantly improved in the vulnerable older adults who received home health-care services. These services need to focus on high-risk groups with frailty and depression. In particular, early intervention is needed for younger elderly people, and more professional and focused management is needed for those aged 85 and above.
Adult ; Aged* ; Delivery of Health Care* ; Depression* ; Early Intervention (Education) ; Frail Elderly ; Home Care Services ; House Calls* ; Humans ; Logistic Models ; Prevalence ; Seoul