Inflammatoire darmziekten (Inflammatory Bowel Disease, IBD) zijn chronische immuun-gemedieerde ziekten van het maag-darmstelsel. Het aandeel oudere patiënten met IBD, 65 jaar of ouder, wordt... Show moreInflammatoire darmziekten (Inflammatory Bowel Disease, IBD) zijn chronische immuun-gemedieerde ziekten van het maag-darmstelsel. Het aandeel oudere patiënten met IBD, 65 jaar of ouder, wordt groter. Het behandelen van deze groep is een uitdaging, omdat zij vaak andere ziekten (comorbiditeit) hebben en geriatrische aandoeningen zoals geheugenproblemen of verminderde spiermassa. Deze aandoeningen vallen onder het begrip kwetsbaarheid, en worden gemeten met een geriatrisch assessment.Dit proefschrift richt zich op het in kaart brengen van de huidige literatuur en behandeloverwegingen bij oudere patiënten met IBD, om daarna als een van de eersten bewijs te leveren voor het invoeren van (screening naar) comorbiditeit en kwetsbaarheid bij de behandeling van oudere patiënten met IBD.Allereerst wordt onderzocht welke factoren bijdragen aan behandelbeslissingen, door behandelaren te interviewen. Leeftijd en aspecten van kwetsbaarheid beïnvloeden behandelbeslissingen, maar behandelaren verschillen onderling in hoe ze deze aspecten gebruiken. Daarnaast liet een literatuur zoektocht zien dat het bewijs over de relatie tussen kwetsbaarheid en behandeluitkomsten schaars is.Ook wordt het verband tussen comorbiditeit en veiligheid van biologicals, medicijnen die ontstekingseiwitten of afweercellen remmen, onderzocht. De aanwezigheid van meer comorbiditeit geeft een hoger risico op bijwerkingen (infecties en ziekenhuisopnames), een hogere leeftijd geeft dat niet.Tenslotte wordt de prevalentie van kwetsbaarheid in een Nederlands cohort van oudere patiënten met IBD onderzocht. Bij ongeveer de helft was er kwetsbaarheid. Hoe kwetsbaarder, hoe hoger de IBD-ziekteactiviteit en de IBD-ziektelast. Kwetsbare patiënten hadden, onafhankelijk van hun leeftijd en IBD-ziekteactiviteit, een hogere kans op ziekenhuisopnames en infecties, maar ook op achteruitgang in zelfstandigheid en kwaliteit van leven. Show less
The life expectancy of individuals has been almost doubled in the past century. The aging population brings challenges to the economic and medical burden of care-needed dependent older people... Show moreThe life expectancy of individuals has been almost doubled in the past century. The aging population brings challenges to the economic and medical burden of care-needed dependent older people limited by age-associated cognitive impairment. Age-associated cognitive decline is a meaningful experience that occurs over the lifespan.This thesis aimed to evaluate the association of cognitive performance with the risk of cardiovascular events and various causes of mortality in elderly populations. The lower cognitive function performance might be an early manifestation of clinically unrecognized cerebral and systemic vascular pathologies, which signals the future risk of cardiovascular events and mortality.In the present research, we included two longitudinal studies, the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) prospective randomized controlled trial in the elderly population of Scotland, Ireland, and the Netherlands that aimed to evaluate whether treatment with pravastatin decreases the risk of cardiovascular events, and Leiden 85-Plus Study which is a prospective population-based study of 85-year-old inhabitants of Leiden district, the Netherlands. Based on our findings and also considering results from other studies, we concluded that cognitive impairment associates with cardiovascular events and several causes of mortality in elderly individuals. Show less
In this thesis the risk factors of venous thrombosis will be discussed in the general and particularly the elderly population. The goal of this thesis is to provide insights on risk factors of... Show moreIn this thesis the risk factors of venous thrombosis will be discussed in the general and particularly the elderly population. The goal of this thesis is to provide insights on risk factors of thrombosis in the elderly population, in order to advance our basic understanding of physiological age-related changes that increase the risk of venous thrombosis and which may ultimately lead to improved personalized interventions. In this chapter firstly background information will be provided on risk factors for venous thrombosis, focussing specifically on age as a risk factor. Secondly, the role of veins and venous valves in the development of venous thrombosis will be discussed and thirdly, global assays as a potential tool to identify patients at high risk for venous thrombosis will be considered. The study populations used in this thesis will discussed, and an outline of this thesis will be provided. Show less
As a result of our ageing population, breast cancer is becoming a disease of the elderly. Unfortunately, most studies investigating the efficacy of treatment do not include older patients and are... Show moreAs a result of our ageing population, breast cancer is becoming a disease of the elderly. Unfortunately, most studies investigating the efficacy of treatment do not include older patients and are not representative for the older population. In this thesis, we investigated whether there is variation in treatment and survival among older women with breast cancer in five European countries. Moreover, we study the long term efficacy of two types of adjuvant endocrine therapy in postmenopausal women. In addition, the effect of age and comorbidities on breast cancer death in the presence of competing mortality is studied. Finally, we investigate whether other endpoints in clinical studies might be more relevant for the older population and we introduce a new endpoint for clinical research in the older population with cancer. Show less
Older women with breast cancer are underrepresented in the available evidence. Therefore, there is no solid evidence on how to treat older women with breast cancer. This thesis has three main... Show moreOlder women with breast cancer are underrepresented in the available evidence. Therefore, there is no solid evidence on how to treat older women with breast cancer. This thesis has three main conclusions: 1. There are large international differences in the treatment strategy of breast cancer among older women. These differences are not associated with a significant difference in prognosis. 2. The presence of comorbidity has an important impact on the general prognosis of older women with breast cancer. We did not show an important association between specific comorbidities or the use of co-medications and the breast cancer specific prognosis. 3. Concerning older women with breast cancer for research, there are very important methodological issues to take into account, including to avoidance of selection bias and the proper methodologies to take in to account the chance of dying from another cause of cancer: the competing risk of mortality. Future research should be done to create a tool which can assist in identifying the individualised treatment strategy for each older woman with breast cancer. This will have to take into consideration patient’s and tumour’s information, as well as the endpoints for each individual patient. Show less
