For Some, Pre-Hospice Care Can Be A Good Alternative To Hospitals

26Jun
2017

Interesting initiative for improving quality and reducing readmissions from skilled nursing facilities

25Jun
2017

Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities – Journal of Community Hospital Internal Medicine Perspectives (free) (RT @HMVJC see Tweet)

In this model of care, a hospitalist-led team, including the resident on the geriatrics rotation, followed patients discharged from the hospital to the skilled nursing facility, leading to significant decrease in readmission rates.

 

Hormone therapy position statement of The North American Menopause Society

21Jun
2017

Who Should Assess the Needs of and Care for a Dementia Patient’s Caregiver?

20Jun
2017

Who Should Assess the Needs of and Care for a Dementia Patient’s Caregiver? – AMA Journal of Ethics (free)

“Physicians have an obligation to check in on dementia patients’ caregivers, and provide support if necessary” (RT @JournalofEthics see Tweet)

 

World Elder Abuse Awareness Day (June 15, 2017)

16Jun
2017

Non–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction

15Jun
2017

Non–Vitamin K Antagonist Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Renal Dysfunction – Journal of The American College of Cardiology (link to abstract – $ for full-text)

Commentary: NOAC Doses: Just Stick to the Label – MedPage Today (free registration required)

“Among the 1,473 patients with a renal indication for dose reduction, 43.0% were potentially overdosed, which was associated with a higher risk of major bleeding”

 

Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders

14Jun
2017

Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentary: Persistent Pain May Increase Dementia Risk – The New York Times (10 articles per month are free)

Cohort of community-dwelling older adults suggests there might be a link.

 

Management of polypharmacy

8Jun
2017

Can Personalized Care Planning Improve Primary Care?

8Jun
2017

Prevention of Catheter-Associated Urinary Tract Infection in Nursing Home Residents

4Jun
2017

Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery

25May
2017

Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)

Commentary: Anti-delirium strategy reduces after-surgery confusion in elderly – Reuters Health (free)

Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.

 

Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults

23May
2017

Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults: The ALLHAT-LLT Randomized Clinical Trial – JAMA Internal Medicine (free) (RT @EricTopol see Tweet)

Editorial: Risks of Statin Therapy in Older Adults (free)

Commentaries: Older adults may not benefit from taking statins to prevent heart disease – Medical News Today (free) AND Pravastatin Doesn’t Improve Clinical Outcomes in Seniors – Physician’s First Watch (free)

Patients > 65 years with moderate hyperlipidemia and hypertension had no benefit from pravastatin for primary prevention. “A nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older” (HR 1.34; 95% CI, 0.98-1.84; P = .07).

 

Pressure ulcer prevention and treatment

19May
2017

Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults

19May
2017

Intra-articular triamcinolone not effective for knee osteoarthritis

17May
2017

Menopausal Hormone Therapy for Prevention of Chronic Conditions

17May
2017

Draft Recommendation Statement: Menopausal Hormone Therapy: Primary Prevention of Chronic Conditions – U.S. Preventive Services Task Force (free)

Source: USPSTF Recommendation Against HRT for Chronic Conditions Stands – Medscape (free registration required)

“The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women”.

 

Measuring the Burden of Medications in Older Adults near the End of Life

16May
2017

Risk of acute myocardial infarction with NSAIDs

11May
2017

Reducing inappropriate prescribing easier said than done

6May
2017

Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents

2May
2017

UK guideline for the prevention and treatment of osteoporosis

1May
2017

A better way to care for the dying

28Apr
2017

A better way to care for the dying – The Economist (a few articles per month are free) (RT @EricTopol see Tweet)

“How the medical profession is starting to move beyond fighting death to easing it”.

 

After Knee or Hip Replacement, No Place Like Home

27Apr
2017

After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)

See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)

Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)

The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.

 

Exercise interventions for cognitive function in adults older than 50

26Apr
2017

Meta-analysis: Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis – British Journal of Sports Medicine (free)

Source: Exercise Could Benefit Cognition in Older Adults – Physician’s First Watch (free)

“Physical exercise interventions significantly improved cognitive function in adults older than 50 years, regardless of baseline cognitive status”.

 

Caring for High-Need, High-Cost Patients

24Apr
2017

Use of Medications of Questionable Benefit at the End of Life

20Apr
2017

Prostate Cancer Screening Draft Recommendations – USPSTF

12Apr
2017

Prostate Cancer Screening Draft Recommendations – U.S. Preventive Services Task Force (free)

Viewpoint: The US Preventive Services Task Force 2017 Draft Recommendation Statement on Screening for Prostate Cancer: An Invitation to Review and Comment – JAMA (free)

See also: Should you get screened for prostate cancer? We break down the latest advice – STAT News (free)

For those aged 55 to 69 it recommends “informed, individualized decision making based on a man’s values and preferences”. According to a useful infographic from the draft recommendations, the benefits are likely small. For every 1000 men offered PSA based screening over a period of 10-15 years, the test would avoid cancer spreading in 3 men and death from prostate cancer in 1-2 men, with the undesired consequences of false positives and subsequent procedures in many patients.

 

How Many Pills Are Too Many?

12Apr
2017

How Many Pills Are Too Many? – The New York Times (10 articles per month are free)

“Evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications” (from Tweet)

 

Management of Osteoarthritis of the Hip

12Apr
2017

Seniors are given so many drugs, it’s madness

10Apr
2017

Seniors are given so many drugs, it’s madness – The Globe and Mail (free) (RT @RasoiniR)

“While most prescribing is well-intentioned, it’s also unco-ordinated; there is a tendency to overmedicate and leave people on drugs for too long”.

 

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

5Apr
2017

American College of Radiology (ACR) Appropriateness Criteria Adds Topics

4Apr
2017

ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.

 

Management of Inpatient Hyperglycemia and Diabetes in Older Adults

4Apr
2017

Cognitive Dysfunction in Older Adults With Diabetes

3Apr
2017

Cognitive Dysfunction in Older Adults With Diabetes: What a Clinician Needs to Know – Diabetes Care (free)

Source: Management of Older Adults With Diabetes and Cognitive Dysfunction – PracticeUpdate (free registration required)

“Recommendations include the need for simplified medication regimens, avoidance of glucose-lowering drugs with a high risk of hypoglycemia, periodic reassessment of glycemic goals, and repeated education of the patient and caregiver” (from PracticeUpdate commentary above)

 

Impact of total knee replacement practice: cost effectiveness analysis

31Mar
2017

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative – The BMJ (free)

See also: Knee Replacement Should Be Reserved for More Severe Osteoarthritis, Study Suggests – Physician’s First Watch (free)

Total knee replacement for patients with osteoarthritis had minimal effects on quality of life in this study. Severely affected patients seem to benefit the most from the procedure.

 

Approach to preventive care in the elderly

31Mar
2017

Pregabalin for Acute and Chronic Sciatica

23Mar
2017

Trial of Pregabalin for Acute and Chronic Sciatica – New England Journal of Medicine (link to abstract – $ required for full-text)

Pregabalin did not reduce pain and was associated with higher incidence of adverse events.

 

Genetic assessment of age-associated Alzheimer disease risk

23Mar
2017

Dementia Across the Lifespan and Around the Globe

23Mar
2017

Prosthetic joint infection management

23Mar
2017
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