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The revenge of the radioactive lady
In 1953, Dr. Wilson Spriggs gave Marylou Ahearn a radioactive cocktail without her consent as part of a secret government study that had horrible consequences. For 50 years she's been plotting her revenge. At last she's found Spriggs.
Book
Ageing in urban neighbourhoods
Many western nations have experienced a rise in the number of marginalised and deprived inner-city neighbourhoods. Despite a plethora of research focused on these areas, there remain few studies that have sought to capture the 'optimality' of ageing in place in such places. In particular, little is known about why some older people desire to age in place despite multiple risks in their neighbourhood and why others reject ageing in place. Given the growth in both the ageing of the population and policy interest in the cohesion and sustainability of neighbourhoods there is an urgent need to better understand the experience of ageing in marginalised locations.
This book aims to address the shortfall in knowledge regarding older people's attachment to deprived neighbourhoods and in so doing progress what critics have referred to as the languishing state of environmental gerontology. The author examines new cross-national research with older people in deprived urban neighbourhoods and suggests a rethinking and refocusing of the older person's relationship with place. Impact on policy and future research are also discussed.
This book will be relevant to academics, students, architects, city planners and policy makers with an interest in environmental gerontology, social exclusion, urban sustainability and design of the built environment.
eBook
Elderly Sustainable Mobility: Scientific Paper Review
The number of elderly people as a proportion of the world’s population is growing significantly. Special attention to the accessibility and mobility requirements of this group is needed. The contribution of this paper is a review of travel patterns, mode preferences, infrastructure solutions, accessibility indices, mode choice models and datasets as they relate to elderly mobility. Key findings highlight the role of residential location characteristics in shaping elderly travel patterns, helping to explain why research on elderly travel has largely relied on case studies to date. The review also summarizes a range of indices that have been developed to measure public transport and walking accessibility among the elderly, including distance and time-based methods. Future research should consider the dominance of private transport in facilitating elderly mobility and its implications for cities experiencing an aging population.
Journal Article
The fixed period
Trollope's only science fiction novel, written in 1880, is set in the year 1980 on an island near New Zealand where euthanasia for citizens over the age of 67 is compulsory.
Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study
Background. The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. Methods. Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. Results. The three groups (n = 77; mean ± SD, 88 ± 5 years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p = 0.03). Conclusions. Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly.
Journal Article
The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study
Background
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.
Methods
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.
Results
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (
p
< 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.
Conclusion
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.
Trial registration
Clinicaltrials.gov:
NCT04321265
, registered 19 March 2020.
Journal Article
The effect of geriatric intervention in frail older patients receiving chemotherapy for colorectal cancer: a randomised trial (GERICO)
Background
Older patients with colorectal cancer (CRC) experience chemotherapy dose reductions or discontinuation. Comprehensive geriatric assessment (CGA) predicts survival and chemotherapy completion in patients with cancer, but the benefit of geriatric interventions remains unexplored.
Methods
The GERICO study is a randomised Phase 3 trial including patients ≥70 years receiving adjuvant or first-line palliative chemotherapy for CRC. Vulnerable patients (G8 questionnaire ≤14 points) were randomised 1:1 to CGA-based interventions or standard care, along with guideline-based chemotherapy. The primary outcome was chemotherapy completion without dose reductions or delays. Secondary outcomes were toxicity, survival and quality of life (QoL).
Results
Of 142 patients, 58% received adjuvant and 42% received first-line palliative chemotherapy. Interventions included medication changes (62%), nutritional therapy (51%) and physiotherapy (39%). More interventional patients completed scheduled chemotherapy compared with controls (45% vs. 28%,
P
= 0.0366). Severe toxicity occurred in 39% of controls and 28% of interventional patients (
P
= 0.156). QoL improved in interventional patients compared with controls with the decreased burden of illness (
P
= 0.048) and improved mobility (
P
= 0.008).
Conclusion
Geriatric interventions compared with standard care increased the number of older, vulnerable patients with CRC completing adjuvant chemotherapy, and may improve the burden of illness and mobility.
Trial registration
ClinicalTrials.gov ID: NCT 02748811.
Journal Article