Hypotonic PEG solution is as effective as isotonic PEG in the treatment of constipation in elderly institutionalized patients. Both treatments appear safe, well tolerated and, when dissolved in water, well accepted by the majority of the patients. When desired, switching from isotonic to hypotonic PEG can safely take place in elderly individuals without compromising efficacy.

Serious adverse events associated with electroconvulsive therapy (ECT) are uncommon and consist mostly of cardiovascular complications, mainly arrhythmias. The risk of complications is increased in elderly and physically ill patients. In the current study, a 24-hour pre-ECT and 24-hour post-ECT Holter recording was performed on 26 elderly patients during their first ECT treatment. ECT caused a significant increase in bigeminy/trigeminy and supraventricular tachycardia, but did not increase other arrhythmias. Pre-ECT arrhythmias correlated with post-ECT arrhythmias. All patients in the current study completed the ECT course. Thus, the clinical significance of arrhythmias remains uncertain. The present findings support the usual practice of continuous electrocardiogram monitoring during ECT and recovery.

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Upper gastrointestinal endoscopy has proved to be safe and gives a high diagnostic yield in elderly people. [1][2][3][4][5] The prevalence of gastrointestinal diseases increases with age, and elderly people are also more vulnerable to the complications of these diseases. We retrospectively studied 154 gastroscopies performed in patients aged 85 years or more to clarify the indications for and clinical findings of gastroscopy in very old people. We also studied the influence of the examination on treatment and symptoms. 11 October 1993 and 3 October 1996, 190 gastroscopies were performed in this department on patients aged 85 years or more. Seven patients were excluded because of failed intubation and 13 because of inadequate records. Sixteen re-endoscopies were also excluded; thus 154 gastroscopies were included in the study. The mean age of patients was 88.5 years (range 85-101). Women had 132 and men 22 examinations; this sex distribution was similar to that of all elderly patients treated in the hospital. Overall, 111 patients lived at home while the rest lived in old people's homes or were in hospital; 110 endoscopies were performed on inpatients and 44 on outpatients. Most patients had one or more chronic diseases-for example, 78 patients had ischaemic heart disease. The patients had received an average of 5 different drugs (range 0-14). To avoid hypoxia, which leads to complications in elderly people, supplemental oxygen was given and premedication, sedation, and pharyngeal lignocaine (lidocaine) spray were not used. Patients, methods, and results BetweenOne indication alone seldom led to gastroscopy. The main indications were epigastric pain (83 patients), anaemia (55), vomiting (22), and nausea (20). Only two endoscopies gave normal results. The most common findings in the other 152 were gastritis, oesophagitis, and prepyloric or pyloric ulcer (table). There were no major complications related to endoscopy, and 154 efforts were successful while intubation was unsuccessful in seven patients. Endoscopy revealed the diagnosis explaining patients' symptoms in 93 of the 154 examinations. Drug treatment was changed in 119 patients, the most common change being to stop treatment with non-steroidal antiinflammatory drugs and start treatment with proton pump inhibitors. CommentGastroscopy was safe and well tolerated in this study. There were no major complications, although most of the patients had one or more chronic diseases and were taking an average of five different drugs. Only seven gastroscopies were excluded because of patients' lack of cooperation, but all patients had dementia.Normal findings were found in only two examinations, which is fewer than in previous studies. 2-5Gastroscopy revealed a diagnosis in more than half of the cases, and drug treatment was changed after 77% of the examinations. The findings were mostly amenable to drug treatment, and subjective improvement was often achieved.All but one of the patients studied were referred for endoscopy by a doctor working in the department of geri...

Background The increasing trend of opioid use for non-malignant pain among older people has raised concerns about whether opioids are used for appropriate indications. On the other hand, pain in patients with dementia may be undertreated. Aims To examine the prevalence of and indications for daily opioid use among home care clients, and to determine opioid use differs between those with and without dementia. Methods All home care clients aged ≥ 65 years using opioids daily (n = 282) were identified based on their first Resident Assessment Instrument-Home Care assessment in 2014. Exact indications for opioid use, the opioid substance used, the median duration of use, and changes in opioid medication within 12 months from study entry were obtained from the electronic medical records. Results The prevalence of daily opioid use was 9.3%, and the median duration of use before the study entry was 357 days (interquartile range 126-719 days). The majority of clients continued to use opioids daily during the follow-up year. Vertebral osteoporotic fractures (21.6%), degenerative spinal disorders (20.9%), and osteoarthritis (20.6%) were the most common indications for opioid use. Buprenorphine was used more frequently in persons with dementia, but otherwise there were no differences between those with and without dementia. Discussion and conclusions Home care clients use opioids for long periods of time for pain related mostly to musculoskeletal disorders, although the effectiveness of long-term opioid use is not clear. The lack of effective or suitable options for management of pain might explain the situation.