Open access

NEWS - Geriatrics

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”.


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”.


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