Geriatrics
M-A | Global and regional prevalence of multimorbidity in the adult population in community settings
22 Feb, 2023 | 12:47h | UTCSummary: The article presents a systematic review and meta-analysis of surveys that estimate the prevalence of multimorbidity among adults in community settings. The study analyzed data from 126 peer-reviewed studies, including nearly 15.4 million people from 54 countries worldwide. The overall global prevalence of multimorbidity was 37.2%, with South America having the highest prevalence, followed by North America, Europe, and Asia. The study also found that females have a higher prevalence of multimorbidity than males, and that more than half of the adult population worldwide above 60 years of age had multimorbid conditions.
Related:
Costs of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: a narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
22 Feb, 2023 | 12:43h | UTCSummary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.
Related:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
Presence of pyuria remains the cornerstone of UTI diagnosis However, >90% of ASB patients have pyuria,prompt unnecessary Rx
🆕️⚡️⚡️study: current pyuria cut-off is too low promote inappropriate UTI diagnosis in older women suggesting a new higher cut offhttps://t.co/qAGdwSTiU6 pic.twitter.com/Vr63RnuMv1— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) February 20, 2023
Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license
Bacteriuria in older adults triggers confusion in healthcare providers: a mindful pause to treat the worry
22 Feb, 2023 | 12:42h | UTCRelated:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
FANTASTIC⚡️⚡️
The evidence base for refraining from screening for or treating ASB in elderly is strong,but both practices remain prevalent
Bacteriuria in older adults triggers confusion in healthcare providers:A mindful pause to treat the worry #IDTwitter https://t.co/7ispdtFeFB pic.twitter.com/kOB5eGKkAc— Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 (@ABsteward) January 10, 2023
Under a http://creativecommons.org/licenses/by/4.0/ license
Study finds low rates of antipsychotic medication discontinuation in older adults following infection-related hospitalization
20 Feb, 2023 | 12:25h | UTCSummary: The study aimed to investigate discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization and infection in older adults. The cohort study involved 5,835 patients in the US, who were aged 65 years or older, without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. The study found that only 11% of new atypical APM users and 52% of new haloperidol users discontinued the medication by 30 days after initiation. The discontinuation of haloperidol and atypical APM was less likely to occur in patients with dementia and prolonged hospitalization. The findings suggest that APM discontinuation rates following infection-related hospitalization are low, especially for atypical APM, and call for effective interventions to proactively discontinue APMs when they are no longer indicated.
Phase 2b RCT | Ad26.RSV.preF–Respiratory Syncytial Virus preF protein vaccine is immunogenic in older adults
17 Feb, 2023 | 13:30h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine’s efficacy, immunogenicity, and safety in preventing RSV-mediated lower respiratory tract disease in adults aged 65 years and older. The vaccine was effective in preventing the disease and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity. The trial concluded that Ad26.RSV.preF–RSV preF protein vaccine was effective in preventing RSV-mediated lower respiratory tract disease in older adults.*
Article: Efficacy and Safety of an Ad26.RSV.preF–RSV preF Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Ad26.RSV.preF-RSV preF Protein Vaccine Immunogenic in Seniors – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
RCT | Respiratory Syncytial Virus prefusion F protein vaccine provides protection for older adults
17 Feb, 2023 | 13:32h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine in adults aged 65 years and older. The vaccine was effective and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity.*
Article: Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Respiratory syncytial virus causes clinically significant illness in children and adults. In a placebo-controlled trial, a prefusion stabilized F protein vaccine led to an 83% lower risk of RSV infection. https://t.co/aU9BV0LXBU pic.twitter.com/0zy1hu0VH6
— NEJM (@NEJM) February 15, 2023
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
Review | Integrating geriatric assessment and prehabilitation into surgical practice can improve outcomes for GI cancer patients with frailty
17 Feb, 2023 | 12:37h | UTC
SR | Predisposing and precipitating factors associated with delirium
15 Feb, 2023 | 15:38h | UTC
Developments under assisted dying legislation: the experience in Belgium and other countries
14 Feb, 2023 | 11:02h | UTCSummary: The legalization of assisted dying (including euthanasia and physician-assisted suicide) remains a controversial issue as more countries consider such laws. A selective literature review was conducted to examine the developments globally, and the experience in Belgium was found to be instructive. Since legalization, the practice of assisted dying has increased gradually, accompanied by a growing acceptance among the public and physicians. Although fears have been largely alleviated, ongoing monitoring and research are necessary to address important concerns. Research in Belgium has not found evidence of harmful effects, but the implementation of assisted dying laws should always consider integration into the healthcare system, physician training, conscientious objection, availability of palliative care, public education, and monitoring systems. To ensure the quality of end-of-life care, it is advisable to set up monitoring and evaluation systems and carry out impartial studies. It is important to have high levels of openness and involvement with healthcare providers and the general public.
(By ChatGPT, reviewed and edited)
Study suggests long-term caloric restriction could slow biological aging in healthy adults
14 Feb, 2023 | 10:52h | UTCSummary: The article reports the results of a study that analyzed the impact of caloric restriction (CR), defined as reducing caloric intake without depriving essential nutrients, on DNA methylation, a measure of aging, in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial. The results showed that the CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks. The authors note that while treatment effect sizes were small, a modest slowing of the pace of aging can have a significant impact on population health. They also highlight the need for further trials with long-term follow-up to establish the effects of interventions on primary healthy-aging endpoints, including the incidence of chronic disease and mortality.
(By ChatGPT, reviewed and edited)
Commentaries:
Restrict calories to live longer, study says, but critics say more proof is needed – CNN
RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care
13 Feb, 2023 | 12:50h | UTCDeprescribing Medications Among Older Adults From End of Hospitalization Through Postacute Care: A Shed-MEDS Randomized Clinical Trial – JAMA Internal Medicine (free for a limited period)
Related:
Deprescribing proton pump inhibitors – Australian Journal of General Practice
Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports
Deprescribing in Palliative Cancer Care – Life
Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360
Polypharmacy Management in Older Patients – Mayo Clinic Proceedings
Eliminating Medication Overload: A National Action Plan – Lown Institute
Common ED Medication Errors: Polypharmacy – emDocs
Current and future perspectives on the management of polypharmacy – BMC Family Practice
Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international
Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety
Commentary on Twitter
A randomized trial of patient-centered #deprescribing in the acute care setting reduced medication burden by 14% among older hospitalized patients that needed ongoing post-acute care. https://t.co/FJf53O00Cv #ShedMEDS #polypharmacy #LessIsMore #Geriatrics
— JAMA Internal Medicine (@JAMAInternalMed) February 9, 2023
Cohort Study | Middle-age high normal serum sodium as a risk factor for chronic diseases and premature mortality
9 Feb, 2023 | 13:38h | UTCNews Release: Good hydration linked to healthy aging – National Institutes of Health
M-A | Prevalence of polypharmacy and potentially inappropriate medication use in older lung cancer patients
9 Feb, 2023 | 13:24h | UTC
Review | Management of menopausal symptoms
8 Feb, 2023 | 12:44h | UTCManagement of Menopausal Symptoms: A Review – JAMA (free for a limited period)
Audio Clinical Review: Treatment of Menopausal Symptoms – JAMA
RCT | Laser no better than sham treatment for genitourinary syndrome of menopause
8 Feb, 2023 | 12:17h | UTCLaser versus sham for genitourinary syndrome of menopause: A randomised controlled trial – BJOG (link to abstract – $ for full-text)
Invited commentary: Laser therapy for genitourinary syndrome of menopause: Emperor’s new clothes or a meaningful advance? – BJOG
Related:
M-A | Carbon dioxide laser vs. vaginal estrogen for genitourinary syndrome of menopause.
Perspective: From vaginal laser treatment to spa breaks – it’s the great menopause gold rush.
Guideline | Delirium: prevention, diagnosis and management in hospital and long-term care
7 Feb, 2023 | 14:21h | UTC
SR | Cognitive stimulation to improve cognitive functioning in people with dementia
7 Feb, 2023 | 13:59h | UTCCognitive stimulation to improve cognitive functioning in people with dementia – Cochrane Library
Summary: Can cognitive stimulation benefit people with dementia? – Cochrane Library
Updating international consensus on best practice in care of the dying: a Delphi study
6 Feb, 2023 | 13:41h | UTC
SR | Which interventions decrease ED attendances or hospital admissions from long-term care facilities?
6 Feb, 2023 | 13:04h | UTC
Commentary from the author on Twitter (thread – click for more)
🚨 FIRST PUBLICATION: Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. #generalpractice #gp #research https://t.co/p53a3RnPyc
— Ben Searle (@bsearle92) February 3, 2023
M-A | Effect of aquatic physical therapy on chronic low back pain
3 Feb, 2023 | 13:57h | UTC
Cohort Study | Association between antiepileptic drugs and incident Parkinson disease
3 Feb, 2023 | 13:51h | UTCAssociation Between Antiepileptic Drugs and Incident Parkinson Disease in the UK Biobank – JAMA Neurology (link to abstract – $ for full-text)
Commentary on Twitter
This study using @uk_biobank data found evidence of an association between anti-epileptic drugs and incident #ParkinsonDisease. https://t.co/58PMlWQUYU
— JAMA Neurology (@JAMANeuro) December 28, 2022
Review | High prevalence of geriatric conditions among older adults with cardiovascular disease
1 Feb, 2023 | 13:30h | UTCRelated:
M-A | Comparative efficacy of exercise therapy and oral NSAIDs and paracetamol for knee or hip osteoarthritis
1 Feb, 2023 | 13:28h | UTC
Commentary on Twitter
Network meta-analysis of 152 RCTs (17431 pts) comparing efficacy of exercise therapy, NSAIDs, Tylenol for knee or hip osteoarthritis: Found all 3 equivalent at 4 wk, 8 wk and 24 wks. https://t.co/rKck2AacL4 pic.twitter.com/YEAMh9UxTs
— Dr. John Cush (@RheumNow) January 10, 2023
Podcast | Hearing loss, tinnitus, and Meniere’s disease
31 Jan, 2023 | 13:46h | UTC#379 Hearing Loss, Tinnitus, and Meniere’s Disease – The Curbsiders
SR | Perioperative clinical practice guidelines for care of older adults living with frailty
30 Jan, 2023 | 00:34h | UTC