• Korean Journal of Head & Neck Oncology
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• v.32 no.2
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• pp.5-8
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• 2016

Background and Objectives: The aim of this study was to evaluate the safety and the feasibility of thyroidectomy for aged (${\geq}75$ years old) thyroid cancer by reviewing postoperative morbidity and pathologic characteristics. Materials & Methods: The clinical records of patients submitted to thyroid operation between 2014 and 2015 with histopathological diagnosis of thyroid cancer were analyzed. Clinical variables included age, gender, preoperative symptom, final pathology, length of stay, comorbidities, American Society of Anesthesiologists score, postoperative complications, and mortality. Results: There were 30 patients aged more than 75 years old, and only one patient passed over with postoperative pneumonia. There were 8 male and 22 female patients. Half of the patients presented with symptoms such as palpable mass (33.3%), voice change (6.7%) and dyspnea (6.7%). The pathologic diagnosis was thyroid cancer in all cases. The median postoperative hospitalization time was 4 days. There was one perioperative mortality case observed in this study. Conclusion: Thyroid surgery in patients 75 years or older can be performed except extensive surgical resection. Aggressive histology and extent of surgery may be an important factor of perioperative mortality and morbidity.

• Annals of Geriatric Medicine and Research
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• v.20 no.3
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• pp.114-117
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• 2016

A research project, the "Construction of Frailty Cohort for Elderly and Intervention Study," funded by the Ministry of Health and Welfare, has been ongoing since December 2015. The Korean Frailty and Aging Cohort Study (KFACS) aims to identify risk factors for adverse outcomes associated with frailty in community-dwelling older adults, as well as means of prevention. KFACS is a multicenter, longitudinal study, with the baseline survey being conducted in 2016-2017. The sample (n=3,000) consists of those aged 70-84 years, stratified by age and gender, recruited from urban and rural regions nationwide. An in-person interview and health examination are performed every 2 years. This project is also conducting many intervention studies. Project interventions focus on nutrition and exercise. The nutritional intervention study compares the effects of 1.2 g/kg versus 1.5 g/kg daily protein intake on sarcopenia and frailty in older Koreans. The exercise trial examines the effectiveness of an information and communication technology-based program in preventing or reducing frailty.

• Annals of Geriatric Medicine and Research
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• v.20 no.3
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• pp.125-130
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• 2016

Background: Conventionally, elderly hip fracture patients are assessed by orthopedists to decide whether they need geriatric intervention. We aimed to evaluate the effect of perioperative geriatric intervention on healthcare outcomes in patients undergoing surgery for hip fractures. Methods: Our care model for hip fracture surgery resembles a combination of a routine geriatric consultation model and a geriatric ward model. We retrospectively reviewed the medical records of patients aged ${\geq}65years$ undergoing surgery for hip fracture at a single tertiary hospital from January 2010 to December 2013. We assessed comorbidity, indwelling status, fracture type, and mode of anesthesia. We also evaluated in-hospital expenditure, duration of admission, disposition at discharge and 1-year mortality as clinical outcomes. We developed a propensity score model using the variables of age, cholesterol, and creatinine and examined the effect of perioperative geriatric intervention on intergroup differences of clinical variables. Results: Among 639 patients, 138 patients received the geriatric intervention and 501 patients received the usual care. Univariate analysis showed that factors such as age; Charlson comorbidity index; and serum levels of cholesterol, albumin, and creatinine differed significantly between these 2 groups. There was no significant difference between the groups in terms of 1-year mortality, disposition at discharge, and in-hospital expenditure in the propensity matched model. However, the duration of hospitalization was shorter in the intervention group ($8.9{\pm}0.8days$) than in the usual care group ($14.2{\pm}3.7days$, p=0.006). Conclusion: This care model of geriatric intervention for patients with hip fracture is associated with reduced hospitalization duration.

• Annals of Geriatric Medicine and Research
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• v.22 no.4
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• pp.184-188
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• 2018

Background: The risk factors of nocturia in older adults remain unclear. We aimed to investigate factors associated with nocturia using the National Health and Nutrition Examination Survey (NHANES) data. Methods: Among 40,790 participants, 4,698 participants aged ${\geq}65$ years were included from the NHANES dataset between 2005 and 2012. A multivariate logistic regression analysis was performed to determine the odds ratio (OR) for nocturia. A subgroup analysis was conducted based on sex and underlying diseases. Results: In the multivariate logistic regression model, obesity (OR, 1.46; 95% confidence interval [CI], 1.28-1.68), hypertension (OR, 1.28; 95% CI, 1.07-1.52), and diabetes mellitus (DM) (OR, 1.27; 95% CI, 1.11-1.45) were significantly associated with nocturia. These factors were associated with nocturia regardless of sex. In a subgroup of participants with hypertension, obesity (OR, 1.44; 95% CI, 1.25-1.67) and DM (OR, 1.26; 95% CI, 1.09-1.45) were associated with nocturia. In the additional analysis on patients with DM, nocturia was associated with obesity (OR, 1.33; 95% CI, 1.06-1.67) and duration of DM (OR, 1.02; 95% CI, 1.01-1.03). Conclusion: This study demonstrated that hypertension, DM, and obesity were significantly associated with the prevalence of nocturia in older adult patients regardless of sex. In particular, obesity was associated with nocturia in every subgroup analysis.

• Annals of Geriatric Medicine and Research
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• v.22 no.4
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• pp.189-193
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• 2018

Background: This study aimed to reveal the clinicopathologic features and causes of bleeding in older patients with postmenopausal bleeding (PMB) and to investigate the correlation between the ultrasonographic findings and etiology of PMB. Methods: We retrospectively analyzed the causes and clinical characteristics of PMB in 498 patients who were diagnosed between January 2007 and December 2017. The population with PMB was divided into 2 groups according to age: Group A (n=204) included individuals more than 65 years of age and group B (n=294) included those less than 65 years of age. Clinical characteristics such as age, parity, underlying conditions, previous surgical history, and previous menopausal hormone therapy were compared between the groups. Cervical cytology testing and transvaginal ultrasonography were performed in all patients with PMB. Endometrial biopsy was performed in all cases of endometrial thickness ${\geq}5mm$. Results: We examined 498 patients with PMB. In group A, atrophic endometrium (n=125, 61.27%) was the most common cause of PMB. Twenty-three patients had gynecological malignancy (cervical cancer: n=12, 5.88%; endometrial cancer: n=8, 3.42%; ovarian cancer: n=3, 1.46%), and 30 patients had benign gynecological disease (endometrial polyp: n=10, 4.90%; submucosal myoma: n=6, 2.94%; uterine prolapse: n=7, 3.42%; cervical dysplasia; n=5, 2.45%; cervical polyp: n=2, 0.98%). Forty patients had endometrial thickness ${\geq}5mm$. Eight patients were diagnosed with endometrial cancer. All cases of endometrial cancer were diagnosed with endometrial thickness >10 mm. Conclusion: Atrophic endometrium was the most common cause of PMB in both groups, and approximately 12% of cases were associated with gynecological malignancy in older patients.

• Advances in Computational Design
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• v.4 no.2
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• pp.73-90
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• 2019

The growth in the number of single-member households is a critical issue worldwide, especially among the elderly. For those living alone, who may be unaware of their health status or routines that could improve their health, a continuous healthcare monitoring system could provide valuable feedback. Assessing the performance adequacy of activities of daily living (ADL) can serve as a measure of an individual's health status; previous research has focused on determining a person's daily activities and extracting the most frequently performed behavioral patterns using camera recordings or wearable sensing techniques. However, existing methods used to extract common patterns of an occupant's activities in the home fail to address the spatio-temporal dimensions of human activities simultaneously. Though multiple sequence alignment (MSA) offers some advantages - such as inherent containment of the spatio-temporal data in sequence format, and rapid identification of hidden patterns - MSA has rarely been used to extract in-home ADL routines. This research proposes a method to extract a household occupant's ADL routines from a cumulative spatio-temporal data log of occupancy collected using a non-intrusive method (i.e., a tomographic motion detection system). The findings from an occupant's 28-day spatio-temporal activity log demonstrate the capacity of the proposed approach to identify routine patterns of an occupant's daily activities and to reveal the order, duration, and frequency of routine activities. Routine ADL patterns identified from the proposed approach are expected to provide a basis for detecting/evaluating abrupt or gradual changes of an occupant's ADL patterns that result from a physical or mental disorder, and can offer valuable information for home automation applications by enabling the prediction of ADL patterns.

• Annals of Geriatric Medicine and Research
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• v.22 no.4
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• pp.194-199
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• 2018

Background: The aim of this study was to examine the correlation between the number of remaining natural teeth (NRT) and the appendicular skeletal muscle mass index (SMI) in older adults. Methods: This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys. The participants were 2,378 older participants (984 men and 1,394 women) aged over 65 years. Survey dentists conducted oral health examinations, and ASM was measured using dual-energy X-ray absorptiometry. Results: The participants with $NRT{\geq}20$ had more ASM and SMI than those with NRT<20 in both sexes. SMI was correlated with NRT in men (r=0.018, p<0.001) and in women (r=-0.007, p<0.001). The positive correlation between the NRT and SMI remained significant in men even after adjusting for age, marital status, income, smoking, drinking, physical activity, protein intake, energy intake, calcium intake, body mass index, fasting blood glucose level, medications, and prostheses (${\beta}=0.011$, p=0.001). In women, the correlation disappeared after adjustment for smoking, alcohol, physical activity, protein intake, energy intake, calcium intake, marital status, income, fasting basal glucose, medication administration, and prostheses. Conclusion: This study showed a correlation between NRT and SMI in those ${\geq}65$ years of age in Korea. The relationship persisted in men, but not in women, even after adjusting for confounders.

• Journal of Gastric Cancer
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• v.19 no.2
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• pp.202-211
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• 2019

Purpose: Poor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middleterm results: 30-day and 3-, 6-, 12-, and 36-month mortality rates. Materials and Methods: A retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29-50 years (group I, n=27), 51-65 years (group II, n=117), 66-75 years (group III, n=81), and 76-92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV. Results: The middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course. Conclusions: Age is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.

• Journal of Gynecologic Oncology
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• v.29 no.6
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• pp.97.1-97.12
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• 2018

Objective: Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods: The National Cancer Database was queried for patients ${\geq}70$ years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results: Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion: In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.479-506
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• 2021

Background: Chronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP. Methods: Randomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook. Results: The search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0-100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001). Conclusion: Although THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.