SM Gerontology and Geriatric Research

Archive Articles

Article Image 1

Outcomes after Spinal Stenosis Surgery by Type of Surgery among Adults Age 60 Years and Older

Background: Mobility disability due to spinal stenosis is common in the senior population. We assessed the recovery timeline and compared outcomes among seniors undergoing spinal stenosis surgery by type of surgery.

Methods: We investigated 451 patients (77.4 ± 10.9 years, 58% women) of a consecutive cohort prior to spinal stenosis surgery and at 3 or 6-month and at 12-month follow-up. At each visit, pain, neurological dysfunction, and disability were assessed using the North American Spine Society questionnaire. Repeatedmeasures analysis compared outcomes by type of surgery adjusting for baseline symptoms, gender, age, comorbidities, center, and year of surgery.

Results: Most improvement occurred within the first 3 to 6 months with little or no improvement up to 12 months. Over 12 months and in adjusted models, patients receiving one-segment versus multi-segment decompression experienced greater reduction of pain (-46.0% vs. -41.0%; p = 0.05), neurological dysfunction (-36.4% vs. -26.1%; p < 0.001), and disability (-30.5% vs.-26.7%; p = 0.06). Moreover, reduction in pain and neurological function did not differ with or without additional stabilization and extend of decompression. However, patients who received one-segment (-26.7%) or multi-segment (-27.5%) stabilization experienced significantly less reduction in disability after surgery compared with those who were not stabilized (-31.6%; p < 0.05).

Conclusions: Among seniors undergoing spinal stenosis surgery, recovery was largely complete by 3 to 6 months after surgery, and differed little by type of surgery independent of symptoms prior to surgery and other covariates. However, particularly neurological dysfunction and disability may improve more with less invasive surgery.

Thomas Degen¹²³#, Karina Fischer¹²#, Robert Theiler¹², Stefan Schären⁴, Otto W Meyer¹²³, Guido Wanner⁵, Patricia Chocano-Bedoya¹², Hans-Peter Simmen³⁶, Urs D Schmid⁷, Johann Steurer⁸, Hannes B Stähelin⁹, and Heike A Bischoff-Ferrari¹²³*


Article Image 1

Content Analyses of Telephone Followup of Older People with Chronic Heart Problems using the Omaha System

Background: This study is a secondary analysis of the process of telephone follow-up of communitydwelling older people with chronic heart disease after index hospitalization. Objective: The objectives of the study were to understand the common problems encountered and the interventions provided by telephone, using the Omaha System as a framework.

Methods: The intervention nurse conducted assessments and interventions based on the system. Patient problems were categorized according to the system. Thirty-four sets of audio recordings, with a total of 896 minutes of verbatim from 17 participants, were transcribed and analyzed.

Results: The results identified the 5 most frequent problems and described the interventions most frequently prescribed by the intervention nurse. Circulation was the only physiological problem among the top problems identified. Nutrition, medication regime, physical activity and healthcare supervision were the common healthrelated behavioral problems cited at the initial and final call. Surveillance was the most frequent category of intervention, followed by teaching, guidance and counseling as the second most frequent category of intervention provided to the participants in the study.

Conclusions: A better understanding is needed of the process of care provided by the intervention nurse via telephone to older people with chronic heart disease in the community. The body of knowledge can extend the continuum of care provided to people living with chronic heart disease in the community. Further study on the integration of low and high technology would enhance the health surveillance and counseling of older people with chronic heart disease

Katherine Ka Pik Chang* and Frances Kam Yuet Wong


Article Image 1

Chronic Inflammatory Demyelinating Polyneuropathy in Older Adults

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare immune mediated disorder of the peripheral nervous system which can occur at any age but is more common in older males. Clinical features can include weakness, sensory loss, and gait impairment which may lead to significant functional loss and difficulty managing ADLs and IADLs independently in the elderly population. This case report will highlight why primary care providers need to be aware of CIDP.

Begum R¹²* and Suh T¹²³