Older patients

The short-acting clomethia2ole [533-45-9] (1), sometimes used as therapy for sleep disorders ia older patients, shares with barbiturates a risk of overdose and dependence. Antihistamines, such as hydroxy2iae [68-88-2] (2), are also sometimes used as mild sedatives (see HiSTAMlNES AND HISTAMINE antagonists). Antidepressants and antipsychotics which have sedative effects are used to treat insomnia when the sleep disorder is a symptom of some underlyiag psychiatric disorder. 

Moore J, Seiter K, Kolitz J et al (2006) A Phase II study of Bcl-2 antisense (oblimersen sodium) combined with gemtuzumab ozogamicin in older patients with acute myeloid leukemia in first relapse. Leuk Res 30(7) 777-783... 

A. smaller doses of the drug are usually given to older patients... 

Angina is a common problem in older adults When an older adult requires an antianginal drug, the dosage maybe reduced to compensate for impaired renal function or heart disease. Older patients are at increased risk for postural hypotension. Blood pressure and ability to ambulate should be monitored closely. 

There is an increased incidence of bleeding in individuals older than 60 years (particularly older women) when heparin isadministered. The nurse should carefully monitor older patients for evidence of bleeding. 

Histopathological examination shows the typical corelike lesions in a high proportion of muscle fibers in older patients this may amount to 100%. Most typically the cores are large and centrally-placed, but multiple cores may occur in the same fiber cross section. Most older patients show a striking predominance of type 1 (slow twitch oxidative) fibers and virtually all fibers with cores are type 1. Sometimes younger family members have more normal proportions of type 1 and type 2 fibers but, again, the cores are confined to the type 1 fibers. It is well established that muscle fiber types can interconvert due to altered physiological demands, and it is likely that fibers with cores convert to a basically slow twitch-oxidative metabolism to compensate for the fact that up to 50% of their cross sectional area may be devoid of mitochondria. 

Generally, best results are achieved in depressed and atrophic or rolling and boxcar scars. Icepick scars always need to be preceded by punch excision. Our experience shows that in older patients, when skin is less elastic, it is possible to achieve more significant improve-... 

In older patients these lesions are commonly seen on the face and back of the hands after chronic sun exposme (Figs. 18.2) [1]. 

Many clinicians are concerned about the use of DC for dominant hemisphere strokes, but Kastrau et al. found in a retrospective review of 14 dominant hemisphere stroke patients with aphasia that significant improvement (13/14 patients) was achieved in these preselected younger patients who underwent early poststroke DC. In contrast, a retrospective study by Foerch et al. found that older patients fared quite poorly in terms of functional outcome and quality of life, especially in those with severe neurological deficit at admission. These results were replicated by Curry et al., who also found that younger patients also were more likely to require reoperations for continued herniation. Uhl et al. ° found no prognostic value to the side of infarction in their analysis of 188 patients who underwent DC for massive hemispheric infarction. 

Lesser RP, Liiders DH, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985 26(6) 622-630. 

Age prevalence of hypertension is likely to be highest with middle-age or older patients. 

Susceptibility factors can be readily used to develop screening programs for CKD. For example, older patients, those with low kidney mass or birth weight, and those with a family history of kidney disease should be routinely screened for CKD. 

Hyperosmolar Hyperglycemic State Hyperosmolar hyperglycemic state (HHS) is a life-threatening condition similar to DKA that also arises from inadequate insulin, but HHS occurs primarily in older patients with type 2 DM. DKA and HHS also differ in that HHS lacks the lipolysis,... 

Older patients ear pain (mild, moderate, or severe), ear fullness, hearing impairment... 

Duration of therapy, like drug selection, depends on patient age and disease severity. Standard 10-day oral therapy is more effective than shorter courses for uncomplicated AOM in children younger than 2 years of age and those with recurrent infections, as well as in older patients with severe illness.5,24 Exceptions to the 10-day regimen are for azithromycin and ceftriaxone. In older children with mild or moderate illness, antibiotic therapy is needed only for 5 to 7 days. 

The major prognostic factors in newly diagnosed AML are age, sub-type (FAB M2), and chromosome status. Older adults with AML (greater than 60 years), in comparison with younger patients with the same disease, have a dismal prognosis and represent a distinct population in terms of disease biology, treatment-related complications, and overall survival. These older patients have a higher incidence of unfavorable chromosomal abnormalities, such as aberrations of chromosomes 5,7, or 8, and fewer abnormalities that are associated with a more favorable outcome, such as t(8 21) or inv(16) (see Table 92—6).9... 

The proportion of ALL in patients older than age 60 years constitutes between 16% and 31% of all adult leukemias. Treatment of adults largely has followed the conventional chemotherapeutic regimes used in childhood ALL. However, the intensification regimens common in childhood are not suitable for this population because of their associated toxic-ities in older patients. The adverse prognostic factor, the Philadelphia chromosome, occurs in 15% to 30% of adults and thus is more common in the over 60 age group.17 Based on the experience achieved in CML, the use of imatinib, a potent inhibitor of the Ph+-associated BCR-ABL tyrosine kinase, is becoming a common practice for these older adults. Results show that the combination of imatinib with conventional chemotherapy has improved remission rates compared with the use of conventional chemotherapy alone,... 

The primary goals in the treatment of CLL are to provide palliation of symptoms and to improve overall survival. Since the current treatments for CLL are not curative, reduction in tumor burden and improvement in disease symptoms are reasonable end points, particularly in older patients. A response to therapy can be evaluated by a resolution of lymphadenopathy... 

Chemotherapy does not improve overall survival in early-stage CLL In addition, deferring therapy until a patient becomes symptomatic does not alter overall survival.19,20 For this reason, the notion of watch and wait is considered reasonable for older patients with indolent disease. 

Successful treatment in the older CLL patient depends on the reduction of malignant lymphocytes. Treatment often begins when a patient becomes symptomatic. A desirable response to therapy includes a reduction in lymphocytes, decrease in stage of the disease, and resolution of symptoms. Since CLL is not a curable disease, palliation of symptoms is a reasonable goal in older patients, and aggressive therapies are reserved for younger patients with high-risk CLL. 

Radiation is not standard therapy for the treatment of skin cancer however, there are circumstances in which radiation may be preferred. It is used as adjunctive therapy after surgical resection for patients with head and neck MM with metastasis to regional lymph nodes.40 Radiation is also indicated for patients with unresectable metastases or brain metastases or for palliation of symptoms from metastases.40 Older patients or patients who are poor candidates for surgery may be offered radiation as an option.40 Radiation offers good cosmetic results,... 

Macrophage 250- or 500-mcg vial size Bone pain Injection-site skin reaction older patients with AML Limited experience and lack of FDA approval for prevention of febrile neutropenia... 

Hyperosmolar hyperglycemic state A potentially fatal short-term complication most commonly seen in older patients with type 2 diabetes caused by an insufficiency of insulin action that leads to alterations of osmolality and hyperglycemia, but without the ketosis and acidosis seen in diabetic ketoacidosis. 

Additionally, when reviewing the various liquid preparations available in the OTC market today, one can see that many of these products are now sugar- or sodium-free or both. Indeed, decreased sodium and sugar levels are beneficial to the entire population. This would seem to suggest that every elfort should be made to keep sodium and sucrose contents to an absolute minimum in products intended for use in older patients. 

Blumenthal, James A., Michael A. Babyak, Kathleen A. Moore, W. Edward Craighead, Steve Herman, Parinda Khatri, Robert Waugh, Melissa A. Napolitano, Leslie M. Forman, MarkAppelbaum, P. Murali Doraiswamy and K. Ranga Krishnan, Effects of Exercise Training on Older Patients with Major Depression , Archives of Internal Medicine 159 (1999) 2349-56... 

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