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- Egenvall, Monika, et al.
(författare)
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Management of colon cancer in the elderly : a population-based study
- 2014
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 16:6, s. 433-441
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Tidskriftsartikel (refereegranskat)abstract
- AIM: although the median age of patients diagnosed with colon cancer is above 70 years, little is known about specific characteristics and management in the elderly. The aim of the study was to define characteristics of colon cancer in elderly patients and compare the quality of preoperative assessment and surgery with that of younger patients undergoing surgery for colon cancer.METHOD: data on 15.255 patients diagnosed with colon cancer between 2007 and 2010 were retrieved from the Swedish National Colon Cancer Register. Of these, 12.959 underwent surgical resection, 6.141 were 75 years or older while 6.818 were younger. The χ(2) test, Mann-Whitney U test and uni- and multivariable logistic regression analyses were used for comparison between groups.RESULTS: older patients were more likely to be female (54% older/48% younger) and have right-sided cancer (60% older/49% younger). Among patients who underwent resection, the elderly were less often evaluated regarding tumour stage prior to surgery (59% older/65% younger) and they were less often evaluated at a multidisciplinary team conference (26% older/34% younger). Elderly patients more frequently underwent emergency surgery (22% older/19% younger) despite having an earlier cancer stage. When adjusted for stage, fewer elderly patients underwent a radical curative procedure (OR for non-curative resection 1.19; 95% CI 1.06-1.33)CONCLUSION: routine management of patients with colon cancer is age-dependent. Patients 75 years and older are less often completely staged and less often evaluated at a multi-disciplinary team conference prior to surgery. Adjusted for stage, fewer elderly patients undergo curative resection.
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| 2. |
- Klarin, Inga
(författare)
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Drug use in the elderly : are quantity and quality compatible
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The increasing number of elderly, and the increasing drug use among the elderly, emphasizes the need to continuously monitor drug utilization in this group. The scarcity of randomized controlled trials including elderly people give population-based, observational studies an important role as source of information on drug use and drug-related problems. The aim of this thesis was to explore drug consumption patterns and quality in people aged ≥ 75 years within the Kungsholmen Project, a population-based, longitudinal study 1987-2001. Cross-sectional data from the urban cohort in Kungsholmen, Stockholm and cross-sectional and longitudinal data from the rural cohort in Nordanstig, Hälsingland were used. Over 90% of the participants used drugs, with a mean of five drugs per person 1999-2001. The pattern was consistent with morbidity patterns in old age. The most common drug classes were cardiovascular drugs, nervous system drugs, and drugs for the alimentary tract and metabolism. Polypharmacy was common, especially among the oldest old. Drug use increased over time, and the utilization patterns were fairly stable regarding drugs for chronic diseases, as opposed to a larger turnover of users of drugs for mainly temporary conditions. Regional differences in the drug use patterns among the oldest old were found. Vasodilators in cardiac disease with an odds ratio 95% confidence interval [OR (95% CI)] of 2.51 (1.46-4.30), and high ceiling diuretics 2.62 (1.77-3.90) were used more often, and "Antithrombotic agents" less often 0.43 (0.29-0.65) in the rural area compared to the urban area. ACE-inhibitors were used by only one fourth of the participants with heart failure (HF) diagnosis in Nordanstig. Crude data suggested an even lower utilization of ACE-inhibitors by demented or cognitively impaired participants with HF, but after adjustment for covariates the significance disappeared. However, advanced age was associated with lower use with an OR (95% CI) of 0.11 (0.01-0.95) for being a user if aged ≥90 compared with 75-79 years, and there was also lower use by those living in institutions compared to community-living: 0.28 (0.09-0.91). Other quality issues were fairly frequent use of calcium channel blockers with negative inotropic effects, and of NSAIDs, practices not recommended in patients with HF. Inappropriate drug use (IDU), as defined by consensus-based criteria, was an increasingly common phenomenon over time with some intra-individual variability. At baseline in Nordanstig approximately one fifth of the participants used at least one inappropriate drug regiment. IDU increased with number of used drugs. An association was found between being a user of at least one inappropriate drug and at least one hospitalization during three years of follow-up in community residing participants in Nordanstig, OR (95% CI): 2.75 (1.66-4.55). Conclusions: In this study drug use was extensive, and both drugs for chronic diseases and temporary symptoms were common. Some regional differences were found in prescribing behaviours. Inappropriate drug regiments were also common, increasingly so with number of used drugs. There was an association between IDU and hospitalization in community residing participants, suggesting negative health outcomes of IDU. However, despite the high drug utilization there may also have been under-use of modern HF medications. There is potential to improve drug therapy in elderly people.
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| 3. |
- Samuelsson, Katja Schubert, et al.
(författare)
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Preoperative geriatric assessment and follow-up of patients older than 75 years undergoing elective surgery for suspected colorectal cancer
- 2019
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Ingår i: Journal of Geriatric Oncology. - : Elsevier. - 1879-4068 .- 1879-4076. ; 10:5, s. 709-715
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We investigated the predictive value of specific tools used in a Comprehensive Geriatric Assessment (CGA) with regard to postoperative outcome in patients 75 years and older undergoing elective colorectal cancer (CRC) surgery. Furthermore, recovery was followed over the first postoperative year using the same assessment tools.Material and Methods: Baseline clinical and CGA variables including functional and nutritional status, pressure sore risk, fall risk, cognition, depression, polypharmacy, comorbidity, and health-related quality-of-life (HRQoL) were prospectively recorded. Outcome variables were postoperative complications and length of stay (LOS). Patients were likewise followed up at one, three and twelve months postoperatively.Results: Forty-nine patients underwent surgery (median age 81 years). Forty-three per cent had ASA (American Society of Anesthesiologists) class 2 47% had ASA class 3. Postoperative complications occurred in 32.7%. Median LOS was eight days. In univariate analyses, none of the parameters tested predicted postoperative complication or LOS. During follow-up, all patients recovered to baseline values apart from HRQoL which was still reduced at three and twelve months (p = .017). Nutritional status had improved twelve months after surgery (p = .011).Conclusions: No association could be found in this study between the results of a comprehensive geriatric assessment and prolonged length of stay or postoperative complication rate after elective surgery for colorectal cancer. Patients recovered well during the first year after surgery. Quality of life, however, was still lower than prior to surgery.
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| 4. |
- Samuelsson, Katja Schubert, et al.
(författare)
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The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the ERAS concept
- 2018
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. e1580-e1588
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery.BACKGROUND: Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made.DESIGN: Qualitative descriptive study.METHOD: Semi-structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. Inductive content analysis was employed.RESULTS: During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self-care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful.CONCLUSION: Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation. This article is protected by copyright. All rights reserved.
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| 5. |
- Wimo, Anders, et al.
(författare)
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Cohort Effects in the Prevalence and Survival of People with Dementia in a Rural Area in Northern Sweden
- 2016
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 50:2, s. 387-396
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent studies suggest that trends in cardiovascular risk may result in a decrease in age-specific prevalence of dementia. Studies in rural areas are rare.Objectives: To study cohort effects in dementia prevalence and survival of people with dementia in a Swedish rural area.Methods: Participants were from the 1995-1998 Nordanstig Project (NP) (n = 303) and the 2001-2003 Swedish National study on Aging and Care in Nordanstig (SNAC-N) (n = 384). Overall 6-year dementia prevalence and mortality in NP and SNAC-N were compared for people 78 years and older. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for dementia occurrence using the NP study population as the reference group. Cox regression models were used to analyze time to death.Results: The crude prevalence of dementia was 21.8% in NP and 17.4% in SNAC-N. When the NP cohort was used as the reference group, the age- and gender-adjusted OR of dementia was 0.71 (95% CI 0.48-1.04) in SNAC-N; the OR was 0.47 (0.24-0.90) for men and 0.88 (0.54-1.44) for women. In the extended model, the OR of dementia was significantly lower in SNAC-N than in the NP cohort as a whole (0.63; 0.39-0.99) and in men (0.34; 0.15-0.79), but not in women (0.81; 0.46-1.44). The Cox regression models indicated that the hazard ratio of dying was lower in the SNAC-N than NP population.Conclusions: Trends toward a lower prevalence of dementia in high-income countries seem to be evident in this Swedish rural area, at least in men.
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