Open access

NEWS - Geriatrics

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”.


Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis – Open Forum Infectious Diseases (free)

“OFID: Despite guidelines, continued overtreatment of patients with positive urine cultures but no symptoms” (RT @IDSAInfo see Tweet)


Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently – NIHR Signal (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free summary – $ for full-text) AND News Release: Comprehensive geriatric assessment for older adults admitted to hospital (free)

“Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently” (RT @NIHR_DC see Tweet)


Development and validation of QMortality risk prediction algorithm to estimate short term risk of death and assess frailty: cohort study – The BMJ (free)

Editorial: Identifying frailty in primary care (free)

Commentary: Frailty calculator to support GPs in targeting patients for better care – MyScience (free)

See calculators: QMortality®-2017 risk calculator (free) AND QFrailty®-2017 risk calculator (free)

“the tool can reliably estimate risk of dying within 12 months and risk of unplanned admissions among patients aged between 65 and 100 years old” (from MyScience).


Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (link to abstract – $ for full-text)

Related: Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

“Older patients are more likely to be alive and in their own homes at follow-up if they received comprehensive geriatric assessment on admission to hospital”.


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)


Blood pressure targets for hypertension in older adults – Cochrane Library (free)

Full review: Blood pressure targets for hypertension in older adults – Cochrane Library (link to abstract – $ for full-text)

Related guideline: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From ACP and AAFP (free)

“At the present time there is insufficient evidence to know whether a higher BP target (less than150 to 160/95 to 105 mmHg) or a lower BP target (less than 140/90 mmHg) is better for older adults with high BP”


Risk of Stroke With Various Types of Menopausal Hormone Therapies: A National Cohort Study – Stroke (link to abstract – $ for full-text)

Source: EvidenceAlerts

This large cohort confirms an increased stroke risk with oral hormone therapies, but suggests no increased risk of stroke with transdermal or vaginal estrogen application.


Lithium Use, but Not Valproate Use, Is Associated With a Higher Risk of Chronic Kidney Disease in Older Adults With Mental Illness – The Journal of Clinical Psychiatry (link to abstract -$ for full-text)

Case-control study suggests Lithium is associated with increased risk of chronic kidney disease.


A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission – BMJ Open (free) (RT @NIHR_DC)

Alternatives to hospital admission for people aged over 65 years can be safe and reduce costs across a range of acute and chronic conditions.


Too Many Meds?

5 Aug,2017

Too Many Meds? America’s Love Affair With Prescription Medication – Consumer Reports (free)

See more on “Deprescribing” in our May 8th issue (see #7), May 9th issue (see #4) and May 15th issue (see #2), and also a related article on Current and future perspectives on the management of polypharmacy

“Yes. Way Too Many Meds. Think De-prescribe”. (RT @EricTopol see Tweet)


Tai Chi for Risk of Falls. A Meta-analysis – Journal of The American Geriatrics Society (link to abstract – $ for full-text)

Commentaries: Meta-Analysis: Tai Chi Keeps Seniors from Falling – MedPage Today (free registration required) AND Tai chi may help reduce rate of falls in older and at-risk adults – News Medical (free)

‘Can reduce fall rates by almost half during the first year’ (from MedPage Today)


Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel (free)

“For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery”.


Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis – Health Technology Assessment (free)

Source: ACP Journal Wise ($)

“A national screening programme for atrial fibrillation is likely to represent a cost-effective use of resources, with systematic opportunistic screening more likely to be cost-effective than systematic population screening”


Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery – British Journal of Surgery (link to abstract – $ for full-text)

Source: ACP Journal Club ($ resource to find articles of interest)

In this RCT, a comprehensive preoperative geriatric assessment and optimization before vascular surgery was associated with shorter length of hospital stay, lower incidence of complications, and patients were less likely to be discharged to a higher level of dependency.


Personal Sound Amplification Products vs a Conventional Hearing Aid for Speech Understanding in Noise – JAMA (link to abstract – $ for full-text)

The Jama Network – For the Media: Certain OTC, less expensive hearing aids provide benefit similar to conventional hearing aid (free)

Commentaries: Less Expensive Hearing Devices May Work as Well as Traditional Hearing Aids – Physician’s First Watch (free) AND Study Boosts Case for OTC Hearing Aids – MedPage Today (free registration required) AND OTC Hearing Devices Effective Alternative for Some, Study Shows – Medscape (free registration required)

“Some over-the-counter sound amplification devices are nearly as effective as prescription hearing aids, according to a small JAMA study” (from Physician’s First Watch)


Medical News & Perspectives: Can a Diet That Mimics Fasting Turn Back the Clock? – JAMA (free)

“A Longer Life Through Fasting?” (RT @JAMA_current see Tweet)


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.


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)


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 – 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.


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: 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).


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”.


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 – 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.


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”.


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? – The New York Times (10 articles per month are free)

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


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”.


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.


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