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Practical Geriatrics    2024, 38 (5): 529-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.023 Abstract （77）      PDF （954KB）（810）       Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (8): 851-856.   DOI: 10.3969/j.issn.1003-9198.2024.08.022 Abstract （86）      PDF （1781KB）（793）       Reference | Related Articles | Metrics

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Development of a 6-month risk prediction model for hypoglycemia in elderly patients with type 2 diabetes mellitus: a longitudinal study GUO Chun, YI Mengting, ZONG Qianxing, ZHOU Yi, WU Haidi, MO Yongzhen Practical Geriatrics    2024, 38 (6): 592-597.   DOI: 10.3969/j.issn.1003-9198.2024.06.012 Abstract （72）      PDF （2020KB）（786）       Objective To construct a risk prediction model for hypoglycemia within 6 months in the elderly patients with type 2 diabetes mellitus (T2DM). Methods Convenience sampling was used to select 277 elderly patients with T2DM in Affiliated Geriatric Hospital of Nanjing Medical University from February to August 2022. According to whether hypoglycemia occurred within 6 months of follow-up, the patients were divided into hypoglycemia group (69 cases) and non-hypoglycemia group (208 cases). LASSO regression and multivariate Logistic regression analysis were used to determine the influencing factors, and a nomogram prediction model was constructed and evaluated. Results 24.91% (69/277) of the patients presented with hypoglycemia within 6 months. History of hypoglycemia (OR=6.989, 95%CI: 3.671-13.844, P<0.001) was the risk factor, while high MMSE score (OR=0.890, 95%CI: 0.820-0.959, P=0.003) and triglyceride ≥1.7 mmol/L (OR=0.268, 95%CI: 0.083-0.708, P=0.014) were the protective factors for hypoglycemia in the elderly patients with T2DM within 6 months. The area under the receiver operating characteristic curve (AUC) of the model was 0.801 (95%CI: 0.742-0.860), with a sensitivity of 0.841, a specificity of 0.673, and an accuracy of 71.48%. In the internal validation, the corrected AUC was 0.783, indicating that the model had good discrimination. The Hosmer-Lemeshow goodness of fit test showed that the model had a good calibration (χ2=10.81,P=0.212). The results of clinical decision curve analysis showed that when the prediction threshold of the model was between 0.02 and 0.69, the net clinical benefit level of the patients was the highest. Conclusions The constructed model has good discrimination, calibration and clinical applicability, which can provide a basis for medical staff to identify high-risk group of hypoglycemia and take preventive intervention. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (8): 770-774.   DOI: 10.3969/j.issn.1003-9198.2024.08.004 Abstract （94）      PDF （1174KB）（784）       Reference | Related Articles | Metrics

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Application of humanistic care in elderly patients with amyotrophic lateral sclerosis XIE Zhaomin, LI Xuefen, ZHU Jianying, YU Mengting, LIU Weiguo, YIN Junxiong, LI Yunyi Practical Geriatrics    2024, 38 (5): 537-540.   DOI: 10.3969/j.issn.1003-9198.2024.05.025 Abstract （67）      PDF （962KB）（780）       Objective To investigate the effect of humanistic care-based nursing in the elderly patients with amyotrophic lateral sclerosis. Methods A total of 67 elderly patients with amyotrophic lateral sclerosis admitted to Department of Neurology,Nanjing brain Hospital from February 2021 to March 2023 were enrolled by convenient sampling. All patients’ feelings of care, self-efficacy, emotional state, and quality of life were assessed and compared before and after the application of humanistic care-based nursing. Results After the application of humanistic care-based nursing, the scores of the Care Behavior Inventory (CBI),the General Self-Efficacy Scale (GSES) and Short Form-36 Health Survey (SF-36) were significantly higher, and the scores of each subscale of the State-Trait Anxiety Inventory (STAI) were lower than those before nursing intervention(P＜0.05).The patients’ medication adherence and satisfaction with nursing care were significantly improved after the application of humanistic care-based nursing (P<0.05). Conclusions The application of humanistic care-based nursing in the elderly patients with amyotrophic lateral sclerosis can enhance the patients’ sense of care, improve self-efficacy, emotional state, treatment compliance and nursing satisfaction, and further improve their quality of life. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 516-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.020 Abstract （71）      PDF （975KB）（776）       Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 509-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.018 Abstract （77）      PDF （922KB）（764）       Reference | Related Articles | Metrics

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Effects of HbA1c level on cardiac structure and function in elderly patients with type 2 diabetes mellitus and chronic heart failure LIU Qianhui, YAO Zijun, HE Yuli, XU Yunfan, WU Jun Practical Geriatrics    2024, 38 (5): 491-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.014 Abstract （63）      PDF （1023KB）（751）       Objective To analyze the relationship of glycosylated hemoglobin (HbA1c) level with cardiac structure and function in elderly patients with chronic heart failure and type 2 diabetes (T2DM). Methods A total of 210 elderly patients with chronic heart failure (NYHA gradeⅡ-Ⅳ)combined with T2DM were divided into two groups based on the mean value of HbA1c≤7% or ＞7%.The levels of blood lipid, cardiac structure and function were detected and compared between the two groups.And the correlation of HbA1c with blood lipid, cardiac structure and function were analyzed by Spearman correlation analysis. Results HbA1c ≤ 7% group and HbA1c>7% group showed statistical differences in interventricular septal thickness (IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening rate (Fs), left ventricular ejection fraction(LVEF), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) (P<0.05). Spearman correlation analysis showed that HbA1c level was positively correlated with the levels of IVS, LVPW, TC and LDL-C(r=0.138, 0.152, 0.289, 0.290, P<0.05), and negatively correlated with the level of LVEF(r=-0.196, P<0.05). Conclusions The elderly patients with T2DM and chronic heart failure whose HbA1c level is higher than 7% have higher levels of TC and LDL-C. Controlling the level of HbA1c below 7% can effectively delay the decline of cardiac structure and function. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (8): 766-769.   DOI: 10.3969/j.issn.1003-9198.2024.08.003 Abstract （96）      PDF （1118KB）（732）       Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 433-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.001 Abstract （106）      PDF （1088KB）（722）       Reference | Related Articles | Metrics

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Study on risk factors of intra-dialytic hypotension in elderly patients undergoing maintenance hemodialysis YAN Xiaohong, XIE Qinglei, WANG Yue, ZHOU Hongyun Practical Geriatrics    2024, 38 (6): 549-552.   DOI: 10.3969/j.issn.1003-9198.2024.06.003 Abstract （74）      PDF （1047KB）（710）       Objective To analyze the risk factors for the occurrence of intra-dialytic hypotension (IDH) in the elderly patients undergoing maintenance hemodialysis (MHD). Methods The clinical data of the elderly MHD patients in Blood Purification Center of Zhongda Hospital Southeast University from June 2022 to June 2023 were retrospectively collected and analyzed, including general data, incidence of dialysis-related hypotension and laboratory indicators. Logistic regression was used to analyze hypotension-related risk factors in hemodialysis, and ROC curve was drawn to explore the predictive value of hypotension-related factors. Results A total of 128 elderly patients were enrolled, of which 52 elderly patients presented with a total of 682 times of IDH, with an incidence rate of 7.78%. According to the occurence of IDH, all the patients were divided into IDH group and non-IDH group, and Logistic regression analysis showed that long-term catheter (intra-arteriovenous fistula as reference, OR=7.94, 95%CI: 2.76-22.87, P <0.001), ultrafiltration rate＞8.8 mL/min (≤8.8 mL/min as reference, OR=5.40, 95%CI: 1.55-18.75, P=0.008) were independently associated with IDH. ROC curve analysis showed that the area under the curve (AUC) of the ultrafiltration rate predicting IDH was 0.712, Youden index was 0.357, the optimal cut-off value was 9.0 mL/min, the sensitivity was 67.3% and the specificity was 68.4%. Conclusions Long-term catheter access and ultrafiltration rate > 8.8 mL/min are risk factors for IDH in the elderly MHD patients. Ultrafiltration rate has certain predictive value for IDH in elderly MHD patients. Reference | Related Articles | Metrics

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Relationship between serum thyrotropin and risk of cognitive impairment in elderly with normalthyroid function and subclinical hypothyroidism WEI qian, CAI Yingyuan, WANG Shan,TAN Fuyun, LU Xiaowei Practical Geriatrics    2024, 38 (5): 486-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.013 Abstract （63）      PDF （1155KB）（696）       Objective To investigate the association between serum thyroid-stimulating hormone (TSH) level and cognitive impairment (CI) in the elderly with normal thyroid function or subclinical hypothyroidism (SCH). Methods A total of 292 elderly patients with normal thyroid function or SCH in Department of Geriatrics, Jiangsu Province Hospital from Jul 2016 to Dec 2018 were retrospectively enrolled in this study. Montreal Cognitive Assessment(MoCA)was used to measure the cognitive function. The demographic and clinical data were collected.The restricted cubic spline model and multivariate Logistic regression model were used to explore the correlation between serum TSH concentration and the risk of CI and the dose-response relationship, and subgroup analyses were performed to evaluate the influence of multiple factors on CI. Results The CI group (MoCA < 26, n=230) included 30 cases of SCH, while the non-CI group (MoCA ≥ 26, n=62) had no SCH case, showing a significant difference in SCH prevalence (P<0.001). No significant difference in TSH level were observed between the two groups (P>0.05).Restricted cubic spline showed that the dose-response relationship between TSH and the risk of CI was U-shaped (P=0.047).The SCH patients were set as the SCH group, and those with normal TSH level were divided into normal low group (0.41-1.48 mIU/L), normal middle group (1.49-2.51 mIU/L) and normal high group (2.52-4.50 mIU/L) according to tertile of TSH levels. After adjustment for all confounders, the odds ratios for CI were 0.37(95%CI: 0.16-0.80) and 7.72(95%CI: 2.15-51.02) for the normal high group and SCH group, respectively, compared with the normal low group.Subgroup analysis showed that the serum TSH level was significantly negatively associated with the risk of CI in male subjects and subjects aged 75 years and over (P<0.05). Conclusions Increased serum TSH levels within the normal range may reduce the risk of cognitive impairment. SCH is an independent risk factor for cognitive impairment in the elderly. Reference | Related Articles | Metrics

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Correlation of frailty with serum leptin and 25-hydroxyvitamin D in elderly hemodialysis patients ZHU Bei, HANG Lejia, GAO Fei, YUAN Haichuan, ZHAO Weihong Practical Geriatrics    2024, 38 (6): 603-606.   DOI: 10.3969/j.issn.1003-9198.2024.06.014 Abstract （78）      PDF （1055KB）（691）       Objective To investigate the levels of serum leptin and 25-hydroxyvitamin D [25(OH)D], and to analyze their correlation with frailty in the elderly hemodialysis patients. Methods A total of 150 elderly hemodialysis patients admitted to our hospital from April 2021 to April 2023 were enrolled in this study. The patients were divided into non-frailty group (51 cases), pre-frailty group (74 cases) and frailty group (25 cases) according to Fried phenotype. The general data, serum leptin, 25(OH)D and cardiac function of the three groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of frailty in the elderly hemodialysis patients. Results There were significant differences in age, proportion of diabetes mellitus, dialysis age, left ventricular end-diastolic diameter, albumin, magnesium, IL-6, leptin and 25(OH)D levels among the three groups (P<0.01). Multivariate Logistic regression analysis showed that age, dialysis age, diabetes, magnesium, IL-6, albumin, leptin, 25(OH)D and left ventricular end-diastolic diameter were the independent factors of frailty in the elderly hemodialysis patients (P<0.05). Conclusions It is important to intervene the low level of albumin, high level of leptin and low level of 25(OH)D to delay the progression of frailty in the elderly hemodialysis patients. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 525-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.022 Abstract （177）      PDF （934KB）（668）       Reference | Related Articles | Metrics

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Clinical analysis of the plasma level of melatonin in the elderly patients with sarcopenia ZHOU Lingshan, ZHANG Haiyan, LUO Yin, AO Xiaojun, LIU Rong, YANG Yuan, QIAO Chengdong Practical Geriatrics    2024, 38 (5): 465-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.008 Abstract （73）      PDF （1148KB）（661）       Objective To investigate the level and the clinical significance of plasma level of melatonin in the elderly patients with sarcopenia. Methods A case-control study was conducted. Forty elderly patients with sarcopenia (≥60 years old) who visited Department of Geriatrics, the First Hospital of Lanzhou University from December 2022 to May 2023 were enrolled in the sarcopenia group. Forty elderly patients without sarcopenia in the same period were enrolled in the control group with gender 1∶1 matching condition. The basic clinical data, sarcopenia-related indicators, routine laboratory indicators and plasma level of melatonin were collected and compared between the two groups. Pearson correlation analysis was used to evaluate the correlation between plasma level of melatonin and sarcopenia-related indicators. Multivariate Logistic regression analysis was performed to analyze the independent influencing factors of sarcopenia. And receiver operating characteristic (ROC) curve was used to evaluate the value of melatonin in predicting sarcopenia. Results The plasma level of melatonin in the sarcopenia group was significantly lower than that in the control group(P＜0.01). Plasma level of melatonin was positively correlated with appendicular skeletal muscle index (ASMI) (r=0.520,P＜0.01). Conditional Logistic regression analysis showed that plasma level of melatonin was an independent protective factor for sarcopenia(OR=0.807,P=0.017). ROC curve showed that the best cut-off value of plasma melatonin level in predicting sarcopenia was 3.2 ng/L, with sensitivity of 76.7%, specificity of 68.3%, and the area under the ROC curve was 0.715(P＜0.01). Conclusions The level of plasma melatonin in the elderly patients with sarcopenia is significantly decreased, which can be used as a potential biomarker for sarcopenia. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 442-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.003 Abstract （68）      PDF （1117KB）（659）       Reference | Related Articles | Metrics

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Efficacy and safety of regional citrate anticoagulation during daily continuous venovenous hemodialysis in elderly patients LIU Ziyun, LI Ningxu Practical Geriatrics    2024, 38 (6): 564-567.   DOI: 10.3969/j.issn.1003-9198.2024.06.006 Abstract （97）      PDF （1054KB）（647）       Objective To investigate and evaluate the efficacy and safety of regional citrate anticoagulation (RCA) in elderly patients undergoing daytime continuous venovenous hemodialysis (CVVHD). Methods A total of fifty elderly patients who received daytime RCA-CVVHD treatment from March 2022 to February 2023 in Blood Purification Center, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology were studied retrospectively. Renal function and electrolytes were detected before and after the treatment, and the venous blood gas indicators of the extracorporeal circulation were monitored during the treatment process.The clotting grade of the filter and extracorporeal circulation pipeline was recorded after the treatment. Results (1) All CVVHD in the 50 patients were successfully completed, with no coagulation occurring in the filters and venous pots. (2) The level of ionized calcium (iCa2+) after the filter one hour after the treatment was (0.36±0.05) mmol/L.(3) The blood iCa2+ level was decreased(P<0.05), while the levels of pH, bicarbonate ion (HCO3-), base excess (BE) were increased 2 and 5 h after treatment compared to pre-treatment levels(P<0.05).Sodium ion (Na+) level showed no significant change (P>0.05).(4) The levels of blood urea nitrogen (BUN), serum creatinine (Cr), potassium ion(K+), chloride ion(Cl-), blood phosphate (P) and calcium(Ca2+) were decreased, while the level of HCO3-was increased after treatment (P<0.05). There was no significant change in Na+ level after treatment (P>0.05).(5) There was one case of sodium citrate accumulation during the treatment process. Conclusions The application of daytime RCA-CVVHD in elderly patients is safe and effective. To avoid sodium citrate accumulation or overdose, dynamic monitoring of venous blood gas indicator is necessary during treatment. Reference | Related Articles | Metrics

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Influence of exercise rehabilitation in elderly patients with mild to moderate chronic heart failure WANG Xiaojiao, WANG Ning, CUI Hong, YE Tong, WANG Xiaoming Practical Geriatrics    2024, 38 (8): 775-778.   DOI: 10.3969/j.issn.1003-9198.2024.08.005 Abstract （110）      PDF （1396KB）（645）       Objective To analyze the effect of exercise rehabilitation in the elderly patients with mild to moderate chronic heart failure(CHF). Methods From January 2020 to December 2022, 104 elderly patients with mild to moderate CHF (New York Heart Association cardiac function classification Ⅱ-Ⅲ grade) were randomly divided into two groups, with 52 cases in each group. The control group was given conventional anti-heart failure therapy, and the observation group was given standardized exercise load rehabilitation guidance based on the conventional anti-heart failure therapy. The changes of cardiac function, sleep quality, exercise tolerance, quality of life and the incidence rate of cardiovascular adverse events were observed and compared 6 months after discharge. Results The levels of left ventricular ejection fraction (LVEF), cardiac output (CO) and stroke volume (SV), the score of Minnesota Living with heart failure questionnaire (MLHFQ) and the 6-minute walk distance (6MWD) were significantly higher, while the score of Pittsburgh Sleep Quality Inventory (PSQI) and the incidence of adverse events 6 months after discharge were significantly lower in the observation group than those in the control group(P<0.05). The treadmill exercise time in the observation group was longer than that in the control group. With the extension of treadmill exercise time, acceleration of speed and increase of slope, the heart rate in the two groups was significantly increased, especially in the control group (P<0.05). Conclusions Standardized exercise load rehabilitation guidance can improve exercise tolerance and sleep quality of the elderly patients with mild to moderate CHF, which is worthy of clinical promotion. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 447-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.004 Abstract （81）      PDF （1067KB）（628）       Reference | Related Articles | Metrics

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A Meta-analysis on the efficacy of His-Purkinje system pacing in elderly patients with pacing-induced cardiomyopathy CHENG Rong, ZHOU Haoyang, LI Ying, ZHANG Cheng, LI Chunyu, CHEN Yan Practical Geriatrics    2024, 38 (6): 557-563.   DOI: 10.3969/j.issn.1003-9198.2024.06.005 Abstract （83）      PDF （3268KB）（626）       Objective To evaluate the efficacy and clinical benefit of upgrading to His-Purkinje system conduction system pacing (HPCSP) in the elderly patients with pacing-induced cardiomyopathy (PICM) after right ventricular pacing (RVP). Methods The literatures on Hirsch-Purkinje system (Hirsch-Purkinje system) pacing in the patients with PICM were searched from PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data and VIP Database, based on inclusion and exclusion criteria. The relevant data on clinical efficacy and safety were extracted from the studies, and were analyzed by RevMan 5.4 software. Results A total of 8 literatures were enrolled in this study, and 185 patients were included. The successful rate of HPCSP was 95%. The results of Meta-analysis showed that, compared with baseline, patients’ left ventricular ejection fraction(MD=-11.73, 95%CI:-14.74--8.72, P<0.01)was significantly increased, QRS duration(MD=59.84, 95%CI:55.98-63.70, P<0.01)was shortened, cardiac function classification of New York Heart Association(MD=1.05, 95%CI: 0.70-1.41, P<0.01)was significantly increased. No significant differences were observed in pacing threshold (MD=-0.11, 95%CI: -0.24-0.02, P=0.08) and R-wave(MD=-0.35, 95%CI: -1.94-1.24, P=0.66) before and after the upgrading operation. Conclusions For the elderly patients with PICM, upgrading the pacing mode to HPCSP should be considered. HPCSP can correct electrical dissynchronization and ventricular remodeling caused by long-term right ventricular pacing, and can improve clinical cardiac function and reduce surgery-related complications. Reference | Related Articles | Metrics

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Analysis of status and influencing factors of intrinsic capacity in elderly patients receiving maintenance hemodialysis YAN Xiaowei, LI Mengting, PAN Mengjiao, ZHANG Liuping Practical Geriatrics    2024, 38 (6): 541-544.   DOI: 10.3969/j.issn.1003-9198.2024.06.001 Abstract （95）      PDF （1050KB）（623）       Objective To explore the status and influencing factors of intrinsic capacity (IC) in the elderly patients receiving maintenance hemodialysis (MHD), and to provide evidence for improving the quality of life. Methods Convenience sampling was used to select the elderly MHD patients from the outpatient department of Blood Purification Center of Zhongda Hospital Southeast University from January to June 2023. The general information and clinical data of the patients were collected. The level of IC was evaluated, including the Short Physical Performance Battery(SPPB), Mini Nutritional Assessment short-form(MNA-SF), Mini-Mental State Examination (MMSE), Zung’s Self-rating Depression Scale and self-reported visual/hearing impairment. Results A total of 175 elderly MHD patients were enrolled in this study, with an average age of 69.78±6.92 years, with an average dialysis age of 66.91±55.36 months. Among them, there were 105 males (60.00%), 53 cases (30.29%) with good IC (≥ 3 points) and 122 cases (69.71%) with poor IC (<3 points). The total average score of IC was 2.25±1.03 points. Multiple Logistic regression analysis showed that albumin was a protective factor, and age and β2-microglobulin were independent risk factors for IC in the elderly MHD patients. Conclusions The decline of IC is common in the elderly MHD patients, and high level of albumin could improve the level of IC in the patients. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 521-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.021 Abstract （63）      PDF （952KB）（619）       Reference | Related Articles | Metrics

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Status and influencing factors of symptom perception in elderly patients with heart failure LIU Lin, WU Qing, ZHANG Jing, MAO Fangying, YU Lu, REN Yiting, FANG Ting Practical Geriatrics    2024, 38 (5): 461-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.007 Abstract （85）      PDF （1016KB）（616）       Objective To investigate the status of symptom perception in the elderly patients with heart failure, and to analyze the influencing factors of symptom perception. Methods A total of 468 elderly patients with heart failure were selected by convenience sampling from June 2021 to June 2022 in the cardiovascular department of our hospital. The clinical data within 72 hours of admission were collected. Multiple linear regression was used to analyze the independent influencing factors of symptom perception in the elderly patients with heart failure. Results The average age of 468 elderly patients with heart failure was 73.70±8.04 years, and the total symptom perception score was 43.11±8.69. Educational level, spouse, NYHA cardiac function grade, pacemaker, number of concurrent diseases, social support, health literacy and depression were the independent influencing factors of symptom perception in the elderly patients with heart failure. Conclusions The symptom perception level of the elderly patients with heart failure is at a moderate level, and it will be influenced by many factors. Medical staff should pay more attention to the symptom perception of the patients, and formulate personalized intervention measures from the aspects of demographic factors, disease factors and environmental factors. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (5): 438-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.002 Abstract （97）      PDF （1064KB）（615）       Reference | Related Articles | Metrics

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Predictive value of hypoperfusion intensity ratio combined with systemic immune-inflammation index for early neurological deterioration after thrombolysis in elderly patients with acute ischemic stroke YOU Jiaxiang, LI Xiaoxi, XIA Jun, LI Haopeng, WANG Jun Practical Geriatrics    2024, 38 (6): 598-602.   DOI: 10.3969/j.issn.1003-9198.2024.06.013 Abstract （73）      PDF （1077KB）（610）       Objective To investigate the predictive value of hypoperfusion intensity ratio (HIR) combined with systemic immune-inflammation index (SII) for the occurrence of early neurological deterioration (END) in the elderly patients with acute ischemic stroke (AIS) after thrombolysis. Methods A total of 185 patients with AIS admitted to Department of Emergency of Nanjing Drum Tower Hospital from January 2020 to December 2022 were retrospectively enrolled in this study, and they were divided into END group and non-END group. The baseline data of the two groups were statistically analyzed. Logistic regression model was used to analyze the risk factors for the occurrence of END. The predictive value of HIR and SII for END in the elderly patients with AIS was analyzed by using receiver operating characteristics (ROC) curve. Results There were 41 patients presenting with END, with an incidence rate of 22.2%. The levels of HIR and SII, National Institutes of Health Stroke Scale (NIHSS) score at admission and blood glucose in END group were significantly higher than those in non-END group (P<0.05); Logistic regression analysis showed that higher HIR (OR=1.065, 95% CI: 1.038-1.092), higher SII (OR=1.001, 95% CI: 1.000-1.001), higher NIHSS score at admission (OR=1.063, 95% CI: 1.003-1.127) and higher blood glucose (OR=1.186, 95% CI: 1.039-1.354) were the independent risk factors for the development of END in elderly AIS patients (P <0.05). The results of the ROC curve analysis of the indicators predicting the occurrence of END in the elderly patients with AIS showed that the AUC of HIR, SII, NIHSS score, blood glucose and HIR combined with SII at admission were 0.861, 0.658, 0.728, 0. 665, and 0. 885. Conclusions HIR and SII have important influences on the occurrence of END in the elderly patients with AIS, and the combined detection of HIR and SII has a higher predictive value for the occurrence of END. Reference | Related Articles | Metrics

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Effect of trans-theoretical model on fatigue and psychological health in elderly patients with epilepsy TANG Yue, ZHU Jianying, LIU Weiguo, XIANG Yang, LI Xuefen Practical Geriatrics    2024, 38 (5): 533-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.024 Abstract （75）      PDF （955KB）（609）       Objective To explore the influences of nursing intervention by a trans-theoretical model (TTM) on the psychological health and fatigue status in the elderly patients with epilepsy. Methods A total of 95 elderly inpatients with epilepsy were enrolled from January 2021 to March 2023. Personalized TTM care was performed on all subjects for 3 months. Before and after the intervention, the self-rating anxiety scale (SAS), self-rating depression scale (SDS), revised piper fatigue scale (RPFS), the stage variation and span of TTM, the knowledge of antiepilepsy drugs and the mastery of self-rescue were evaluated and compared. Results After 3 months of behavioral nursing intervention, the scores of SAS, SDS, RPFS, and the stage variation, span of TTM and the mastery of self-rescue in the elderly patients with epilepsy were significantly improved (P<0.05). Conclusions The nursing intervention based on TTM can effectively improve the behavior of the elderly patients with epilepsy, alleviate their anxiety and depression, and relieve fatigue. Reference | Related Articles | Metrics

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Application of enhanced recovery after surgery combined with the improvement of surgical approach in laparoscopic radical prostatectomy WU Rongxin, ZHANG Heng, WANG Yan, HU Mingjin Practical Geriatrics    2024, 38 (6): 629-633.   DOI: 10.3969/j.issn.1003-9198.2024.06.020 Abstract （78）      PDF （1074KB）（606）       Objective To explore the application value of enhanced recovery after surgery(ERAS) combined with the improvement of surgical approach in laparoscopic radical prostatectomy. Methods A total of 30 cases receiving radical prostatectomy were divided into the control group (n=15) and the observation group (n=15). The control group received conventional perioperative treatment, and the surgical method was transperitoneal laparoscopic radical prostatectomy. The observation group received rapid rehabilitation surgical intervention mode, and the surgical method was extraperitoneal laparoscopic radical prostatectomy. The clinical parameters during surgery and after surgery and the complications were compared between the two groups. Results There were no significant differences in operative time and bleeding volume between the two groups (P>0.05). The time of getting out of bed, VAS score, time of anal exhaust, time of indwelling pelvic drainage tube, time of indwelling urinary catheter, hospital stay and medical cost in the observation group were lower than those in the control group (P<0.05). The incidence rates of respiratory symptoms, digestive symptoms, intestinal obstruction, urinary infection and incision infection in the observation group were lower than those in the control group(P<0.05), and the total clinical effective rate of the observation group was higher than that of the control group(P<0.05). Conclusions ERAS combined with the improvement of surgical approach in laparoscopic radical prostatectomy can reduce postoperative complications, speed up the process of rehabilitation and save medical costs, and it is worthy of clinical application and promotion. Reference | Related Articles | Metrics

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Influence of tropical climate on blood pressure, peripheral blood microRNA-146a and Hcy in elderly patients with essential hypertension from northeast China WANG Chao, CHEN Xiaojun Practical Geriatrics    2024, 38 (5): 470-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.009 Abstract （64）      PDF （969KB）（602）       Objective To investigate the influence of tropical climate on blood pressure, peripheral blood microRNA-146a and homocysteine (Hcy) in the elderly patients with essential hypertension from Northeast China. Methods A total of 252 elderly patients with essential hypertension who came to Sanya for winter from the three provinces in Northeast China and admitted to Sanya Central Hospital from October 2018 to January 2022 were enrolled as the study group, and 126 local elderly patients with essential hypertension in Sanya were enrolled as the control group. The blood pressure of all patients were measured and the levels of peripheral blood microRNA-146a and Hcy were detected at the time of the 1st week, the 3rd month and the 6th month in Sanya, and the control rate of hypertension and the incidence rate of adverse reactions and complications were observed and compared between the two groups. Results After 6 months of treatment, the control rate of hypertension in the study group was higher than that in the control group (P<0.05), and was higher than that after 1 week of treatment in the study group (P<0.05). The systolic and diastolic blood pressure, the levels of peripheral blood microRNA-146a and serum Hcy in the study group decreased gradually from the 1st week, the 3rd month to the 6th month (P<0.05). After 3 months and 6 months of treatment, the systolic and diastolic blood pressure, the levels of peripheral blood microRNA-146a and serum Hcy in the study group were lower than those in the control group (P<0.05). Conclusions The tropical climate can relax the smooth muscles of elderly patients with essential hypertension from Northeast China, decrease blood pressure, reduce inflammatory reactions and lower microRNA-146a and Hcy. Thus, the complications and adverse events related to hypertension can be reduced. Reference | Related Articles | Metrics

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Establishment and validation of a Nomogram to predict the risk of pulmonary infection in elderly patients with stroke XU Jinyan, XIA Congcong, YANG Hongmei Practical Geriatrics    2024, 38 (5): 452-437.   DOI: 10.3969/j.issn.1003-9198.2024.05.005 Abstract （77）      PDF （1464KB）（602）       Objective To analyze the risk factors of pulmonary infection in the elderly patients with stroke, and to establish a Nomogram to predict the risk of pulmonary infection in the elderly patients with stroke. Methods A total of 138 elderly patients with stroke admitted to our hospital from January 2020 to December 2022 were enrolled in the study. All patients were divided into infection group and non-infection group according to whether they presented with pulmonary infection. Single factor and multiple factor Logistic regression models were used to analyze the risk factors of pulmonary infection in the elderly patients with stroke,and R software was used to establish a Nomogram to predict the incidence of pulmonary infection. Receiver operating characteristic (ROC) curve was used to analyze the effectiveness of the Nomogram in predicting the incidence of pulmonary infection in the elderly patients with stroke. Results There were 32 cases (23.2%) in the infection group and 106 cases (76.8%) in the non-infection group. The proportions of the cases aged more than 70 years old, smoking history, diabetes, invasive procedures, swallowing dysfunction and disturbance of consciousness in the infection group were higher than those in the non-infection group. Logistic regression analysis showed that age, smoking history, diabetes, invasive procedures, dysphagia and disturbance of consciousness were independent influencing factors for pulmonary infection in the elderly patients with stroke (P<0.05). Hosmer-Lemeshow goodness-of-fit test showed that the Nomogram model exhibited satisfactory concordance between predicted outcome and actual outcome (P>0.05). ROC curve analysis showed that the area under the curve of the Nomogram model in predicting lung infection was 0.860 (95% CI: 0.796-0.925). Conclusions Age, smoking history, diabetes, invasive procedures, dysphagia and disturbance of consciousness are independent risk factors for pulmonary infection in the elderly patients with stroke. The Nomogram model established with the above indicators shows good predictive efficacy. Reference | Related Articles | Metrics

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Practical Geriatrics    2024, 38 (8): 761-765.   DOI: 10.3969/j.issn.1003-9198.2024.08.002 Abstract （151）      PDF （1207KB）（592）       Reference | Related Articles | Metrics