Anemia is common among elderly and is associated with increased morbidity and mortality in this vulnerable age group. Anaemia hampers functional capacity and cognition, increases risk for frequent falls, frailty, dementia, hospitalization, mortality and mobility and ultimately affects the quality of life. Anemia in elderly is divided in three major types: nutritional deficiency, anemia of chronic disease including chronic renal disease and unexplained anemia. A high index of suspicion is required to manage anemia in elders. The symptoms (easy fatigue, decrease appetite, pallor) are usually taken as consequences of advance age. The onset of signs and symptoms are insidious and elders adjust their routine activities to the remaining physical capabilities and physiological adaptations. Anemia may present as worsening of associated disorder like worsening congestive heart failure, cognitive impairment, dizziness and apathy. The evaluation of anemia in elderly involves complete history including dietary, medical illness and medication history and through physical examination to detect any sign suggestive of etiology followed by further investigations accordingly. The treatment of anemia depends on its etiology and severity. In severe anemia, red cell transfusion is required along with treatment of underlying etiology. In unexplained anemia, eryth-ropoietin replacement in higher dose than usual may be needed due to blunted response to erythropoietin. Anabolic steroid supplementation is also beneficial in elderly with anemia.

[ABSTRACT]   Full text not available  [PDF]

Introduction: Chest physiotherapy has long been an established mode of treatment for pulmonary complications after major abdominal surgery. This study aimed to assess the effect of prophylactic chest physiotherapy on the frequency and severity of pulmonary complications following abdominal surgery. Material and Methods: A randomized controlled study of prophylactic chest physiotherapy was conducted among fifty post-operative patients (age > 60 years) who underwent elective open major abdominal surgery and were admitted in surgical ward of a tertiary care center. The patients were randomized into two groups: treatment group (n=25) and control group (n=25). The treatment group patients were given preoperative verbal information and informed consent was taken to undergo chest physiotherapy. In group A (n=15), patients performed incentive spirometry and in group B (n=10), patient performed breathing exercises with pursed lips, deep breathing and coughing hourly. In the control group (Group C, n=25), patients were not given any preoperative chest physiotherapy. Observations: The frequency of pulmonary complications was higher in group C (Atelectasis-12%, Basal pneumonia-28%, Pleural effusion-4%) in comparison to group A (Atelectasis-6.6%, Basal pneumonia-6.6%) and group B (Atelectasis-10%, Basal pneumonia-10%). The frequency of postoperative pulmonary complications after major abdominal surgery was less with spirometry (group A- 40%) compared to other physiotherapy (group B, 50%). Complications were maximum in patients without physiotherapy (group C- 72%). Conclusion: Prophylactic chest physiotherapy significantly reduces the frequency and severity of pulmonary complications following abdominal surgery.

[ABSTRACT]   Full text not available  [PDF]

Objective: To assess the biological risk factors for fall in the elderly patients (≥ 60 years) presenting to the geriatric-medical OPD in a tertiary care hospital. Methods: A cross sectional descriptive study was done at tertiary care center among elderly patients of both sex visiting Geriatric Medicine OPD from November 2015 to March 2017 after informed consent of the study participants. Patient with acute confusion state or patients requiring emergency management were not included. A sample size of 100 patients was included. After taking informed consent, Geriatric assessment was performed in the elderly with the help of internationally validated tools and biological risk factors for fall were then identified. Result: Prevalence of falls was found to be 17%. The statistically significant risk factors identified in this study include postural hypotension (p=0.017), abnormality in gait and balance (p<0.0001), urinary incontinence (p=0.25), functional dependence (p<0.0001), depression (p=0.003) and poly pharmacy (p=0.009). Conclusion: Geraitric assessment even on out patient basis can help us to identify the biological risk factors for fall which enable us to make early interventions for fall prevention.

[ABSTRACT]   Full text not available  [PDF]

Objectives: The study is aimed at assessing the effects of correction of iron deficiency anaemia on health related quality of life on patients treated with parenteral iron, and compares the effects of treatment with intravenous iron and placebo in a randomized controlled trial. Methods: Questionnaire based survey using (SF-8 short form) on health related quality of life in the elderly patients with iron deficiency anaemia (total 51, 2:1 randomised, blinded, control study) was carried out. Patients with severe cognitive or physical impairment were excluded. Observations were tested for significance level. Results: There was significant improvement in the domains of general health, bodily pain, vitality, social functioning, emotional role and overall improvement in physical and mental health as reflected by PCS and MCS scores. The domains of SF-8 with physical functioning, physical role, and mental health improvement were less impressive at 4 weeks as compared to the other five parameters of SF-8. There was no statistically significant difference in SF-8 items (HRQoL) before and after treatment with placebo. Conclusion: Elderly patients with iron deficiency anaemia have reduced HRQoL and parenteral iron treatment resulted in rapid improvements in HRQoL assessed at 4 weeks, significantly greater than placebo, across most of the domains.

[ABSTRACT]   Full text not available  [PDF]

Objective: To study all aspects of delirium including occurrence, risk factors, precipitating causes and outcome in tertiary care hospital catering geriatric medicine services. Methods: A prospective observational study was done among 100 cases of delirium recruited from 520 patients admitted in geriatric block of general medicine ward during a calendar year. Patients were screened for delirium by confusion assessment method. Prevalent delirium and incident delirium was calculated. A set of predisposing risk factors were sought on admission. The cause of delirium was ascertained after full evaluation of patients by taking history, doing physical examination including neurological examination and appropriate investigations. Outcomes were measured in terms of length of hospital stay and inpatient mortality. Results: Out of 520 patients admitted in Geriatric ward during the study period, 100 patients had delirium (study prevalence 19.23%) and out of these, 7 patients developed delirium during hospitalization (study incidence 1.34%). The most common precipitating causes of delirium was infections (41%), followed by stroke (17%) and electrolyte imbalance (11%). Among infections, UTI was the most common cause. The most common predisposing risk factors for delirium were infections (52%), sensory impairment (51%), immobility/ being bedridden (40%), incontinence (32%), hypoxia (29%), electrolyte disturbances (hyponatremia- 22%), dehydration (21%), and poly pharmacy (15%). At the end of the study, mortality was 24% and 38 (38%) patients were recovered from the delirium. Conclusion: Delirium was found in 19.23% admitted geriatric patients and associated with considerable mortality (24%). The most common precipitating and predisposing causes of delirium was infection. After effective management, 38 (38%) patients recovered from delirium and were discharged in stable condition.

[ABSTRACT]   Full text not available  [PDF]

Full text not available  [PDF]