The present manuscript highlights Beers guidelines till date and puts them at a single platform to enable the physicians, academicians, and patients for the safe and timely use of medicines. Potentially inappropriate medications (PIM) are medications in which adverse risks exceed its health benefits. Complex and multiple comorbidities in older adults make them use multiple drugs that further become a reason for exclusion from randomized clinical trials (RCT). Hence, no set guidelines or RCT-based scientific shreds of evidence are available to support prescription decisions. PIM has become an increasingly common problem in older adults; hence the American Geriatric Society updated Beers criteria; the most crucial strategy to check its use/misuse. The Beers criteria have been formulated in 1991 with the help of validated and appropriate screening tools that explain the use/avoidance of various drugs in older adults based on their health status and are being further updated as and when required. This change in Beers criteria is due to some limitations in the study population, emerging adverse drug reactions/new drug molecules, change in pharmacodynamics of medicines with changing physiology of older adults. Beers guidelines are being updated; however, few significant issues that are not being touched by the committee responsible for constituting the criteria.

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Adverse drug reactions (ADRs) are a common cause of hospitalization, increased morbidity and mortality in the elderly. ADRs are difficult to diagnose in the elderly as they often present with nonspecific symptoms such as fatigue, falls, cognitive decline, and constipation. Statins are generally well-tolerated drugs used in the secondary prevention of coronary artery disease. We report a 75-year-old lady who developed jaundice and became bedbound due to statin-induced hepatitis and acute rhabdomyolysis causing proximal myopathy following initiation of atorvastatin 40 mg for the management of coronary artery disease. She had rapid clinical improvement with discontinuation of statin therapy and supportive management. ADR must be considered a part of differential diagnosis in elderly patients during the evaluation of illnesses. In the elderly initiated on statins, it is essential to differentiate benign muscle pain from severe muscle injury with biochemical abnormalities. Prompt discontinuation of statins will lead to rapid improvement and prevent further worsening.

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Introduction: Cancer is a malady of old age. Older people lose autonomy and independence due to age-associated functional decline and adverse consequences of comorbidity. The impact of these variables has an effect on treatment decisions in older cancer patients. Methods: In an observational study, 290 cancer patients aged 60 years or more were evaluated before the initiation of the treatment. They were subjected to a geriatric assessment by various validated assessment tools. Management decisions were as per the prevailing hospital practice. Results: The median age at the diagnosis was 65 years and two-third were males. Lung cancer was the most common (49.3%) diagnosis. The major comorbidities seen were hypertension (34.14%), diabetes (20.34%), and COPD (15%). Depression (57%), cognitive impairment (37%), malnourishment (34%), and vision problem (20%) were common age-related issues observed. Seventy-one percent were dependent in one or more domains of activities of daily living. Eighty-one percent had Eastern Cooperative Oncology Group status score between 0 and 2 (thereby eligible for treatment). In multivariable analysis, good functional status (P < 0.001) and performance status by Karnofsky's Performance Status Scale (P < 0.001) were associated with receiving treatment. Conclusion: Improvement in pretreatment functional status by initial geriatric assessment and requisite interventions may improve the access to and consideration of older cancer patients for standard treatment and care in oncology clinics.

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Background and Objectives: COVID-19 pandemic took a significant toll on all, especially elderly individuals, who seem to have a higher risk for severe disease and mortality. We aim to study the clinicoepidemiological profile of COVID-19 in elderly patients of South-Eastern Rajasthan and to assess its severity and outcome. Methods: A retrospective analysis of 200 reverse transcription-polymerase chain reaction confirmed COVID-19 patients aged ≥60 years admitted between May and October 2020 in the dedicated COVID hospital of a tertiary care center of South-Eastern Rajasthan was done. Results: The median age of patients was 66 years (interquartile range [IQR]: 63–72 years). Twenty-five percent, 26.5%, and 48.5% cases fell under mild, moderate, and severe disease, respectively, with 52 nonsurvivors. The mean age of severe (68.78 ± 7.20 years) cases was significantly more than that of mild ones (65.96 ± 5.29 years, P = 0.048). Males (70.5%) and urban population (90%) were more affected than females (29.5%) and the rural ones (10%). 67.5% patients had comorbidities. The presence of multiple comorbidities was significantly associated with increased severity (P = 0.03). The median duration of symptoms was 4 days (IQR: 3–7 days). 19% presented asymptomatically. Complications included acute respiratory distress syndrome (47%), renal impairment (31%), hepatic dysfunction (30%), myocardial injury (30%), shock (10.5%), stroke (2%), encephalopathy (2%), acute STEMI (1.5%), deep vein thrombosis (1%), and heart failure (1%). The presence of dyspnea (P = 0.000), desaturation (P = 0.000), leukocytosis (P = 0.000), neutrophilia (P = 0.000), lymphopenia (P = 0.000), high neutrophil-to-lymphocyte ratio (P = 0.000), hyperglycemia (P = 0.015), renal impairment (P = 0.024), elevated creatine kinase-MB (P = 0.020), raised transaminases (P = 0.002), hypoproteinemia (P = 0.003), hypoalbuminemia (P = 0.000), A:G ratio reversal (P = 0.000), low high-density lipoprotein cholesterol (P = 0.000), and higher computed tomography severity score (P = 0.000), all were associated with both increased severity and mortality. Need of vasopressor support was significantly associated with older age (P = 0.022). Conclusion: Increasing age, multiple comorbidities, severe category, and complications are associated with poor prognosis in elderly patients.

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Introduction: With demographic transition and increase in life expectancy elderly population has increased substantially in recent years. Rapid growth in the elderly population resulted in high magnitude of noncommunicable diseases leading to physical disability, dependency on caregivers and poor quality of life. This study aimed to determine the prevalence and correlates of physical disability among elderly rural population in a community development block. Subjects and Methods: A community-based cross-sectional study was conducted in Bhatar block of Purba Bardhaman district from November 2020 to January 2021 among 350 elderly participants ≥60 years selected by multistage random sampling. With prior informed consent, data were collected using semi-structured pre-designed, pretested schedule and 10-item Barthel index. Bivariate and multivariable logistic regression was done to find out the correlates. Results: The prevalence of physical disability among elderly was 28.9% and proportion was more in ≥70 years age group, 62.6% of the subjects suffered from one or more chronic diseases. In bivariate analysis age (odds ratio [OR] = 5.36), caste (OR = 2.27), education (OR = 4.57), current employment status (OR = 0.13), type of family (OR = 2.15), socioeconomic status (OR = 4.04) and presence of any chronic diseases (OR = 1.86) was significantly associated with physical disability. Multivariable analysis revealed age (adjusted OR [AOR] = 2.96 [1.54–5.68]), education (AOR = 2.98 [1.60–5.54]) and current employment status (AOR = 0.23 [0.09–0.58]) as significant predictors. Conclusions: The prevalence of physical disability among elderly is substantially high in the study area. Effective promotive, preventive, curative, and rehabilitative geriatric health care services need to be strengthened for early diagnosis and treatment of health problems in the elderly.

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Objective: Comparative analysis of expression of lupus erythematosus (LE) in geriatrics versus adults. Materials and Methods: We analyzed and compare the patient's records attending our department between June 2017 and June 2019, diagnosed clinically and immunologically as LE between the two groups. Results: Sixty patients, 30 in each group, met ACRA criteria, were enrolled with mean age of presentation for early-onset was 28 ± 9.8 years and late-onset, 59 ± 4.8 years. Most of the patients were females with decrease in sex ratio with age. The most common presentations were malar rash, photosensitivity, and oral ulcers. Joint complaints, lung and cardiac involvement, and nonscarring alopecia were more common in the elderly. Direct Coombs test positive hemolytic anemia, renal involvement in forms of proteinuria and lupus nephritis, and neurological involvement were seen more commonly in adults. In immunological parameters, antinuclear antibody, anti-double standard DNA antibody (AntiDsDNA), and anti-smith antibody testing were done. AntiDsDNA positivity was more in adults correlate with disease severity. We calculate the systemic LE disease activity index 2000 score was higher in the adult population. Conclusion: Our study illustrated that disease activity and damage are more in adults in comparison to geriatrics. However, geriatrics had more organ damage that may be attributable to associated comorbidities. Although the connective tissue diseases in the elderly needs less aggressive management, it requires more attention for possible organ damage due to associated comorbidities.

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Chronic active Epstein–Barr virus infection (CAEBV) is relatively uncommon and can be associated with lymphoproliferative diseases (LPD's) of NK/T cell and B cell type. In the western world, the disease is less common, while it is found to be more prevalent in the East Asian, South, and Central American population. The presentation widely varies from skin rashes, fever, lymphadenopathy to major organ involvement and usually takes a fulminant course. Here, we describe a 70-year-old Indian male, who was diagnosed as CAEBV-related LPD with spontaneous regression with a brief review of the literature.

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