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NEWS - Geriatrics

Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 – The Lancet Neurology (free)

Invited Commentary: Statistics on the burden of dementia: need for stronger data – The Lancet (free)

“In 2016, globally, 43·8 million individuals lived with dementia, increased from 20.2 million in 1990; dementia was the fifth leading cause of death globally (2·4 million) and more women than men had dementia” (via @TheLancet see Tweet with infographic)

 


Antipsychotic drug use and pneumonia: Systematic review and meta-analysis – Journal of Psychopharmacology (link to abstract – $ for full-text)

Commentary: Antipsychotics May Increase Risk of Pneumonia, Meta-Analysis Suggests – Psychiatric News Alert (free)

“Although antipsychotic use was associated with a higher risk of pneumonia, the researchers stopped short of claiming causality, citing a lack of data from randomized, controlled trials and a failure of observational studies to control for relevant confounders like tobacco use and weight.” (from Psychiatric News Alert)

 


Diagnostic value of symptoms and signs for identifying urinary tract infection in older adult outpatients: Systematic review and meta-analysis – The Journal of Infection (free)

“A number of symptoms and signs typically associated with UTI, such as nocturia, urgency and abnormal vital signs, were of limited use in older adult outpatients.”

 


Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis – The BMJ (free)

“Using the adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using the live attenuated vaccine, but the adjuvant recombinant subunit vaccine also carries a greater risk of adverse events at injection sites.”

 


Shingrix: A New Vaccine for Shingles – Therapeutics Initiative (free)

“Need to vaccinate 31 people to prevent one instance of HZ; Need to vaccinate 358 people to prevent one instance on post herpetic neuralgia” (via @amtejani)

 


Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women – Cochrane Library (free)

“Based on the data available, we can be confident that pelvic floor muscle training can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence”

 


Deprescribing recommendations: An essential consideration for clinical guideline developers – Research in Social and Administrative Pharmacy (free)

Related: Position Statement: Reducing Inappropriate Medication Use & Polypharmacy (several articles and commentaries on the subject)

““Clinical guidelines often do not accommodate frailty or patients with multiple comorbid conditions. This can give rise to complex medication regimens and risk of medication harm.” Paper discusses the need to include deprescribing in clinical guidelines” (via @Deprescribing see Tweet)

 


Modifying the consistency of food and fluids for swallowing difficulties in dementia – Cochrane Library (free for a limited period)

Summary: Modifying the consistency of food and fluids for swallowing difficulties in dementia (free)

“We are uncertain about the immediate and long-term effects of modifying the consistency of fluid for swallowing difficulties in dementia”

 


Management of Chronic Wounds—2018 – JAMA (free for a limited period)

 


Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study – The BMJ (free)

Editorial: Primary prevention with statins for older adults (free)

Commentaries: Expert reaction to study on use of statins in older people – Science Media Centre (free) AND Widespread use of statins in healthy older people to prevent heart disease not recommended in new study – BMJ, via ScienceDaily (free)

“New research does not support widespread use of statins in healthy older people to prevent heart disease and stroke. Results found that any protective effect was limited to those with type 2 diabetes aged between 75 and 84” (via @bmj_latest see Tweet)

 


Antidepressants for treating depression in dementia – Cochrane Library (free for a limited period)

Summary: Antidepressants for treating depression in dementia – Cochrane Library (free)

“On the only measure of efficacy for which we had high-quality evidence (depression rating scale scores), antidepressants showed little or no effect.”

 


Earwax, Of All Things, Poses Unrecognized Risk In Long-Term Care – Kaiser Health News (free)

“Of all the indignities that come with aging, excessive earwax may be the most insidious… when it goes unrecognized, it can pose serious problems, especially for the 2.2 million people who live in U.S. nursing homes and assisted living centers.”

 


Special Issue: Roles of Physicians in Healthy Dying- AMA Journal of Ethics (free articles)

“What the roles of clinicians and patients should be in defining what constitutes a quality dying experience and good care of dying people has received less attention than issues like euthanasia and assisted death. Which parts of dying, if any, should be medicalized and why? What do patients and clinicians need to know about dying and why? The August 2018 issue of the AMA Journal of Ethics explores these and other questions.”

 


How Do You Want to Die? – The New York Times (10 articles per month are free)

“Are we turning sudden cardiac death into a longer, winding path? Defibrillators can prevent sudden death but they also can take away the sudden-death option.” (via @RasoiniR see Tweet)

 


Breathing Tubes Fail to Save Many Older Patients – The New York Times (10 articles per month are free)

“One-third of patients over age 65 die in the hospital after they are put on ventilators. Doctors are beginning to wonder if the procedure should be used so often”.

 


Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study – Journal of Clinical Psychopharmacology (link to abstract – $ for full-text)

Commentaries: Incidence of Extrapyramidal Symptoms Higher With Certain Antidepressants – MPR (free) AND Antidepressants tied to Parkinson’s-like symptoms – Univadis (free registration required)

“Observational study: Incidence of EPSs with antidepressants. RRs: duloxetine, 5.68; mirtazapine, 3.78; citalopram, 3.47; escitalopram, 3.23; paroxetine, 3.07; sertraline, 2.57; venlafaxine, 2.37; bupropion, 2.31; and fluoxetine, 2.03 (all significant)” (via @psychopharmacol see Tweet)

 


Age-attuned Hospice care: An opportunity to better end of life care for older people – StCristopher’s (free PDF) (via @hospicedoctor see tweet)

“Despite the evidence that more people will die of frailty and multiple long-term conditions than of cancer, our services for those moving towards the end of their life remain focussed on the needs of the latter group”

 


USPSTF Draft Recommendation Statement: Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening (free)

Commentaries: USPSTF urges abuse screening for reproductive-aged women – MedicalXpress (free) AND USPSTF Recommends Screening for Partner Violence in Reproductive-Aged Women – Clinical Advisor (free)

“The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services.”

 


Case managers improve outcomes for people with dementia and their carers – NIHR Signal (free)

Original Article: The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components – BMC Health Services Research (free)

“The review suggests that nurses may be particularly well placed to act as case managers for people with dementia, perhaps because they have the skills to perform the broad range of tasks associated with the role.” (via @NIHR_DC see Tweet)

 


The Clinical Trial Is Open. The Elderly Need Not Apply – The New York Times (10 articles per month are free)

Related: Cardiac Patients in Trials Don’t Reflect Real-World Populations (link to abstract and commentaries on the subject)

“There’s a shocking lack of data on effective treatments for older people. So what do doctors do? Make guesses”. (via @NYTHealth see Tweet)

 


Percutaneous vertebroplasty for osteoporotic vertebral compression fracture – Cochrane Library (link to abstract – $ for full-text)

Summary: Featured Review: Vertebroplasty for treating spinal fractures due to osteoporosis – Cochrane Library (free)

High quality evidence shows that vertebroplasty does not provide more clinically important benefits than placebo but may cause people harm”.

 


Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study – The BMJ (free)

“New work in @bmj_latest shows poverty increases ageing. Measured by walking speed. 60 y.o. men of lower social class walk like 66 y.o. men of higher social class. As important as physical inactivity, obesity or diabetes. Worse than smoking”. (via @astaines see Tweet)

 


A Quiet Drug Problem Among the Elderly – The New York Times (free)

Related: Our Other Prescription Drug Problem – New England Journal of Medicine (free) AND Benzodiazepines: our other prescription drug epidemic – STAT (free)

“Despite warnings from experts, older people are using more anti-anxiety and sleep medications, putting them at risk of serious side effects and even overdoses”.

 


Elder Abuse: Sometimes It’s Self-Inflicted – The New York Times (10 articles per month are free)

“The house is filthy. The elderly resident is struggling. But who has the right to intervene?” (via @NYTHealth see Tweet)

 


Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer’s Disease: Systematic Review and Network Meta-analysis – Journal of the American Geriatrics Society (free)

Source: Medscape (free registration required)

“Cognitive enhancers in general have minimal effects on cognition according to minimal clinically important difference and global ratings. The drugs appear safe, but this must be interpreted cautiously because trial participants may have less comorbidity and fewer adverse effects than those treated with these drugs in clinical practice”.

 


Short-Term Versus Long-Term Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Elderly Patients: A Meta-Analysis of Individual Participant Data From 6 Randomized Trials – JACC: Cardiovascular Interventions (link to abstract – $ for full-text)

Commentary: Dual Antiplatelet Therapy Duration in Elderly Patients – American College of Cardiology, Latest in Cardiology (free)

Short-term Dual Antiplatelet Therapy was not associated with increased risk of ischemic events in elderly patients and was associated with a significant reduction in major bleeding.

 


Electroconvulsive therapy and age: Age-related clinical features and effectiveness in treatment resistant major depressive episode – Journal of Affective Disorders (link to abstract – $ for full-text)

“Short-term ECT outcome in the treatment of depression in elderly is equivalent to that of young patients in efficacy and tolerability. Old patients reported faster ECT response than younger ones and required less sessions to achieve response and remission” (via @psychopharmacol see Tweet)

 


Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study – PLOS One (free) (via @DrMeganHoseyPhD)

“One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital”

 


One Day Your Mind May Fade. At Least You’ll Have a Plan – The New York Times (10 articles per month are free)

Free download: Health Directive for Dementia (free PDF) from Advanced Directive for Dementia

Source: New document allows advance planning for dementia – Univadis (free registration required)

“A Simple Way to Document the Medical Care You Would Want If You Had Dementia”

 


Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free)

Commentary : Age itself is not a risk factor for complications after surgery among older patients – OnMedica (free)

“Q: What predicts poor outcome after elective surgery in older people?

A: Frailty, cognitive impairment, depression, smoking but NOT age per se”. (via @trishgreenhalgh see Tweet)

 


Supporting Patients Through Serious Illness and the End of Life: Sutter Health’s AIM Model – The Commonwealth Fund (free)

“By proactively managing care for the terminally ill, the Advanced Illness Management program has produced savings of $8,000–$9,000 per patient” (via @commonwealthfnd see Tweet)

 


Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults – Journal of the American Geriatrics Society (link to abstract – $ for full-text)

“Interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults. Implementation of these successful interventions in healthcare systems may improve medication safety in older adults”.

 


Prescribing Cascade in a Cardiology Practice – American College of Cardiology, Latest in Cardiology (free)

“Before starting a medication to treat a new medical condition, consider whether this condition could be a drug-related adverse event. Specifically, consider whether this could represent a prescribing cascade”.

 


Practice guideline update summary: Mild cognitive impairment – American Academy of Neurology (free PDF)

Commentary: Mild cognitive impairment: a practice guideline update – Clinical Advisor (free)

“For patients diagnosed with MCI, clinicians may choose NOT to offer cholinesterase inhibitors”.

“If clinicians choose to offer cholinesterase inhibitors, they must first discuss with patients the fact that this is an off-label prescription not currently backed by empirical evidence”.

 


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