Dialysis Is a Way of Life for Many Older Patients. Maybe It Shouldn’t Be – The New York Times (10 articles per month are free)

Related: Editorial: Prioritizing Patient and Caregiver Values in the Delivery of High-Quality Medical Management Without Dialysis (free)

“So-called conservative management can ease symptoms without dialysis in some people with kidney disease. But many of them are never given the option.”


Deprescribing benzodiazepine receptor agonists taken for insomnia: a review and key messages from practice guidelines – Polish Archives of Internal Medicine (free PDF)

Related: Guideline: Deprescribing Benzodiazepines (free guideline and resources) AND Position Statement: Reducing Inappropriate Medication Use & Polypharmacy (several articles and commentaries on the subject)



American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults (free)

News Release: For older people, medications are common; AGS Beers Criteria aims to make them appropriate, too (free)

Commentary: AGS: Beers Criteria for Potentially Inappropriate Med Use in Older Adults Updated – MPR (free)


Related Commentary on Twitter


When Is the Surgeon Too Old to Operate? – The New York Times (free)

Related: Perspective: Assessing the Performance of Aging Surgeons (free for a limited period) AND Observational Study: Age and Sex of Surgeons and Mortality of Older Surgical Patients (free study and commentary) AND The Elderly and Driving: When Is It Time to Hit the Brakes? – The New York Times (10 articles per month are free)


Related Commentary on Twitter

Care Practices for Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentaries: End Stage Kidney Disease: Decoding How Patients Decide to Forgo Dialysis – (free) AND Shared Decision-Making About Dialysis Initiation Needs to Improve – Renal & Urology News (free)

“There is need for more patient-centered models of care for advanced kidney disease capable of supporting those who do not wish to start dialysis.”


Effect of a Biobehavioral Environmental Approach on Disability Among Low-Income Older Adults: A Randomized Clinical Trial – JAMA Internal Medicine (free for a limited period)

Commentaries: Home Modifications to Reduce Disability in Older Adults With Functional Disability – JAMA Internal Medicine (free for a limited period)


Related Commentary on Twitter


Vitamin and mineral supplementation for maintaining cognitive function in cognitively healthy people in mid and late life – Cochrane Library (free)

Summary: Vitamin and mineral supplementation for preventing cognitive deterioration in cognitively healthy people in mid and late life – Cochrane Library (free)

Commentary: Preventing dementia: do vitamin and mineral supplements have a role? – Evidently Cochrane (free)


Related Commentary on Twitter


Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-analysis – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentary: Meta-analysis: long-term exercise cuts fall, injury risk in elders – Univadis (free registration required)

Related Study: Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis – Sports Medicine Open (free)


Related Commentary in Twitter


Clinically-assisted nutrition and hydration – British Medical Association (free guideline and other resources)

Commentary: Decisions about clinically-assisted nutrition and hydration: guiding doctors, helping patients – The BMJ Opinion (free)

“just because we can keep someone alive indefinitely, should we?”


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)


Study: Trazodone Associated Risks

30 Nov, 2018 | 02:40h | UTC

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.”


Report: Talking About Dying

26 Oct, 2018 | 01:39h | UTC

Review: A New Vaccine for Shingles

12 Oct, 2018 | 01:44h | UTC

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”


Podcast: Geriatric Psychiatry

5 Oct, 2018 | 01:29h | UTC

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”


Podcast: Geriatric Depression

27 Sep, 2018 | 22:45h | UTC

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.”


Opinion: How Do You Want to Die?

3 Aug, 2018 | 02:57h | UTC

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)


Study: The Plateau of Human Mortality

6 Jul, 2018 | 03:11h | UTC

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”.


NICE Guideline: Hearing Loss in Adults

22 Jun, 2018 | 02:52h | UTC

NICE Guideline: Dementia

22 Jun, 2018 | 02:34h | UTC

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)


Guide: Age-attuned Hospice Care

18 Jun, 2018 | 00:19h | UTC

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”


ASCO Guideline for Geriatric Oncology

24 May, 2018 | 23:37h | UTC

Guideline: Deprescribing Benzodiazepines

16 May, 2018 | 01:01h | UTC

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)