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Publisher: Oxford University Press   (Total: 396 journals)

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Showing 1 - 200 of 396 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 46, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
African Affairs     Hybrid Journal   (Followers: 64, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 91, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 7)
American Historical Review     Hybrid Journal   (Followers: 153, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 145, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 175, SJR: 2.713, CiteScore: 3)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 18, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 8, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 15, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 21, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal  
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 15, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 36, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 42, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 10, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 32, SJR: 0.728, CiteScore: 2)
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 56, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 43, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 52, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 303, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 29, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 165, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 64)
Brain     Hybrid Journal   (Followers: 68, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 48, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 26, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 586, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 88, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 32)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 62, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 2, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 14, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 45, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 5, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 4, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 23, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 25, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 65, SJR: 5.051, CiteScore: 5)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 1.163, CiteScore: 2)
Communication Theory     Hybrid Journal   (Followers: 22, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 27, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 2, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 1)
Current Legal Problems     Hybrid Journal   (Followers: 27)
Current Zoology     Full-text available via subscription   (Followers: 2, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 5, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 4)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.139, CiteScore: 0)
Economic Policy     Hybrid Journal   (Followers: 39, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 24, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 52, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 14, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 27, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 17, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 57, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 186, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 29, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 40, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 15, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 12, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 24, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 30, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 23, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 7, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 33, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 12, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 35, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 22, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 4, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 56, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 15, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 24, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 31, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 28, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 13, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 8, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 71, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access  
Human Reproduction Update     Hybrid Journal   (Followers: 20, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 56, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 52, SJR: 1.591, CiteScore: 3)
ICSID Review     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 10, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 35, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 44, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.319, CiteScore: 2)
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 60, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 25)
Intl. Health     Hybrid Journal   (Followers: 6, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 37, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 63, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 228, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 26, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 9, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 35, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 11, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 37, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 23, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 45, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 23, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 2, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 46, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 15, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 4, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 40, SJR: 1.226, CiteScore: 2)
J. of Burn Care & Research     Hybrid Journal   (Followers: 9, SJR: 0.768, CiteScore: 2)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.36, CiteScore: 1)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.139, CiteScore: 0)
J. of Communication     Hybrid Journal   (Followers: 53, SJR: 4.411, CiteScore: 5)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 35, SJR: 0.33, CiteScore: 0)
J. of Complex Networks     Hybrid Journal   (Followers: 2, SJR: 1.05, CiteScore: 4)
J. of Computer-Mediated Communication     Open Access   (Followers: 26, SJR: 2.961, CiteScore: 6)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 12, SJR: 0.402, CiteScore: 0)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 5.856, CiteScore: 5)

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Journal Cover
Age and Ageing
Journal Prestige (SJR): 1.989
Citation Impact (citeScore): 4
Number of Followers: 91  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-0729 - ISSN (Online) 1468-2834
Published by Oxford University Press Homepage  [396 journals]
  • Editor’s view
    • Authors: Stott D.
      Pages: 629 - 629
      PubDate: Thu, 02 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy109
      Issue No: Vol. 47, No. 5 (2018)
  • Hip fracture—great steps forward but we still need better evidence. A
           commentary on NICE CG124 and QS16 on fractured neck of femur
    • Authors: Jay R; Hipps D.
      Pages: 630 - 632
      Abstract: AbstractThe National Institute for Health and Care Excellence (NICE) updated its Clinical Guideline and its Quality Standard on hip fracture in 2017. Three quality statements relate to the organisation of care—having a multidisciplinary hip fracture programme, and both operating and starting rehabilitation without delay—while three relate to surgical aspects, the most recent being the requirement to offer total hip replacement rather than hemiarthroplasty for those with displaced intracapsular fractures who could mobilise outdoors with a stick. Some evidence exists to support this, but the timely provision of this more complex and specialised operation presents a logistical challenge to many units. The evidence for many more general aspects of the care of hip fracture patients is still extrapolated from other populations, and more research is needed to guide the care of this specific group.
      PubDate: Wed, 04 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy099
      Issue No: Vol. 47, No. 5 (2018)
  • Hip fractures: are we asking the right questions'
    • Authors: Moppett I.
      Pages: 633 - 634
      Abstract: hipfractureoutcomeolder people
      PubDate: Wed, 04 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy101
      Issue No: Vol. 47, No. 5 (2018)
  • Delirium screening in older patients
    • Authors: Pendlebury S.
      Pages: 635 - 637
      PubDate: Wed, 11 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy103
      Issue No: Vol. 47, No. 5 (2018)
  • Deprescribing: the emerging evidence for and the practice of the
           ‘geriatrician’s salute’
    • Authors: Hilmer S; Gnjidic D.
      Pages: 638 - 640
      Abstract: AbstractThe process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in the individual patient has been given a variety of names including the colloquial ‘geriatrician’s salute’, ‘de-intensification’ and increasingly ‘deprescribing’. The rise of deprescribing as a word with a definition, evidence base and implementation plan, reflects the changing environment in which we practice. In particular, the emphasis on evidence-based medicine and the need to care for our expanding ageing populations, which requires application of components of geriatric evaluation and management by a wider range of health care practitioners. However, there are still significant challenges related to research on the safety, efficacy and implementation of deprescribing. In this commentary, we discuss the current evidence on the effects of deprescribing, emergence of implementation tools to embed deprescribing into the clinical care of older adults, as well as efforts to develop guidelines to improve health care practitioners’ awareness and self-efficacy of deprescribing. Ultimately, judicious prescribing and deprescribing, across a wide range of health care settings, ought to enable older people to use medicines to support their achievable ageing goals.
      PubDate: Fri, 23 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy014
      Issue No: Vol. 47, No. 5 (2018)
  • The role of biomarkers and imaging in the clinical diagnosis of dementia
    • Authors: Bayer A.
      Pages: 641 - 643
      Abstract: AbstractRecognition of dementia relies on a good clinical history, supported by formal cognitive testing, but identifying the subtype of dementia may be wrong in 20% or more of cases. Accuracy may be improved by use of imaging and cerebrospinal fluid (CSF) biomarkers. Structural neuroimaging is recommended for most patients, not just to identify potentially reversible surgical pathology, but also to detect vascular changes and patterns of cerebral atrophy. Functional imaging can help to confirm neurodegeneration and to distinguish dementia subtypes when structural imaging has been inconclusive. Amyloid-positron emission tomography scans reflect neuritic plaque burden and identify the earliest pathological changes in Alzheimer’s disease, but their value outside research settings is still uncertain. A combination of low CSF amyloid β1–42 and high CSF total-tau or phospho-tau also has high predictive power for AD pathology, but diagnostic usefulness decreases with age because of the increased prevalence of AD-type pathology in non-demented people. The need to use biomarkers more routinely will become necessary as disease-modifying treatments become available and accurate subtype diagnosis will be required at an early (ideally pre-dementia) stage. Clinicians should be considering the resources and expertise that will soon be needed for optimal dementia diagnosis.
      PubDate: Thu, 08 Feb 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy004
      Issue No: Vol. 47, No. 5 (2018)
  • Attention, arousal and other rapid bedside screening instruments for
           delirium in older patients: a systematic review of test accuracy studies
    • Authors: Quispel-Aggenbach D; Holtman G, Zwartjes H, et al.
      Pages: 644 - 653
      Abstract: AbstractObjectivedelirium occurs frequently in frail patients but is easily missed. Screening with a rapid, easy-to-use and highly sensitive instrument might help improve recognition. The aim of this study was to review attention, arousal and other rapid bedside screening instruments for delirium in older patients.Methodsa literature search was performed in PubMed, PsycINFO and Embase. We scrutinized forward citations in Google Scholar, and references of included articles and prior reviews. We included studies among older patients that investigated the sensitivity and specificity of delirium screening instruments that could be administered in 3 min or less, and did not require surrogate information. We extracted study characteristics, risk of bias, sensitivity and specificity.Resultswe identified 27 studies among 4,766 patients in hospitals and nursing homes. They tested many different single and several combined screening instruments. Prevalence of delirium varied between 4% and 57%. Only one study scored a low risk of bias on all domains. Sensitivity varied between 17% and 100%, and specificity between 38% and 99%. Of the 22 tests with sensitivity ≥90%, seven also had specificity ≥80% in older patients in general. These results were approximately reproduced for the Observational Scale of Level of Arousal (OSLA) and Richmond Agitation and Sedation Scale (RASS): sensitivity and specificity were >80%.Conclusiontwo arousal tests—OSLA and RASS—had reproduced high sensitivity and specificity in older patients. Nurses can administer these tests during daily interaction with patients. Test accuracy studies about rapid screening tools for delirium superimposed on dementia were scarce.
      PubDate: Wed, 25 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy058
      Issue No: Vol. 47, No. 5 (2018)
  • Do older and younger patients derive similar survival benefits from novel
           oncology drugs' A systematic review and meta-analysis
    • Authors: Arciero V; Cheng S, Mason R, et al.
      Pages: 654 - 660
      Abstract: AbstractBackgroundolder patients are commonly believed to derive less benefit from cancer drugs, even if they fulfil clinical trial eligibility [Talarico et al. (2004, J Clin Oncol, 22(22):4626–31)]. We aim to examine if novel oncology drugs provide differential age-based treatment outcomes for patients on clinical trials.Methodsa systematic review of randomised control trials (RCTs) cited for clinical efficacy evidence in novel oncology drug approvals by the Food and Drug Administration, European Medicines Agency and Health Canada between 2006 and 2017 was conducted. Studies reporting age-based subgroup analyses for overall or progression-free survival (OS/PFS) were included. Hazard ratios (HRs) and confidence intervals (CIs) for age-based subgroups were extracted. Meta-analyses with random effects were conducted, examining patient subgroups <65 and ≥65 years separately and pooled HRs of studies primary endpoints (OS or PFS) compared to examine if differences existed between age-based subgroups. Sensitivity analyses were conducted for cancer type, primary endpoint and systemic treatment.Resultsone-hundred-two RCTs, including 65,122 patients, met the inclusion criteria. One study reported age-based toxicity and none reported age-based quality of life (QOL) results. Pooled HRs [95% CIs] for patients <65 and ≥65 years were 0.61 [0.57–0.65] and 0.65 [0.61–0.70], respectively, with no difference between them (P = 0.14). Sensitivity analyses revealed similar results.Conclusionour results suggest that older and young patients, who fulfil clinical trial eligibility, may derive similar relative survival benefits from novel oncology drugs. There is, however, a need to report age-based toxicity and QOL results to support patient discussions regarding the balance of treatment benefit and harm, to encourage informed decision-making.
      PubDate: Sat, 19 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy079
      Issue No: Vol. 47, No. 5 (2018)
  • Prognostic factors of functional outcome after hip fracture surgery: a
           systematic review
    • Authors: Sheehan K; Williamson L, Alexander J, et al.
      Pages: 661 - 670
      Abstract: AbstractObjectivethis systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery.Designsystematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections.Resultsfrom 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level—anaemia and cognition. We assigned Parkinson’s disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome.Conclusionwe identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
      PubDate: Thu, 12 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy057
      Issue No: Vol. 47, No. 5 (2018)
  • Computerised interventions designed to reduce potentially inappropriate
           prescribing in hospitalised older adults: a systematic review and
    • Authors: Dalton K; O’Brien G, O’Mahony D, et al.
      Pages: 670 - 678
      Abstract: AbstractBackgroundcomputerised interventions have been suggested as an effective strategy to reduce potentially inappropriate prescribing (PIP) for hospitalised older adults. This systematic review and meta-analysis examined the evidence for efficacy of computerised interventions designed to reduce PIP in this patient group.Methodsan electronic literature search was conducted using eight databases up to October 2017. Included studies were controlled trials of computerised interventions aiming to reduce PIP in hospitalised older adults (≥65 years). Risk of bias was assessed using Cochrane’s Effective Practice and Organisation of Care criteria.Resultsof 653 records identified, eight studies were included—two randomised controlled trials, two interrupted time series analysis studies and four controlled before–after studies. Included studies were mostly at a low risk of bias. Overall, seven studies showed either a statistically significant reduction in the proportion of patients prescribed a potentially inappropriate medicine (PIM) (absolute risk reduction {ARR} 1.3–30.1%), or in PIMs ordered (ARR 2–5.9%). However, there is insufficient evidence thus far to suggest that these interventions can routinely improve patient-related outcomes. It was only possible to include three studies in the meta-analysis—which demonstrated that intervention patients were less likely to be prescribed a PIM (odds ratio 0.6; 95% CI 0.38, 0.93). No computerised intervention targeting potential prescribing omissions (PPOs) was identified.Conclusionsthis systematic review concludes that computerised interventions are capable of statistically significantly reducing PIMs in hospitalised older adults. Future interventions should strive to target both PIMs and PPOs, ideally demonstrating both cost-effectiveness data and clinically significant improvements in patient-related outcomes.
      PubDate: Fri, 08 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy086
      Issue No: Vol. 47, No. 5 (2018)
  • Low grip strength predicts incident diabetes among mid-life women: the
           Michigan Study of Women’s Health Across the Nation
    • Authors: Karvonen-Gutierrez C; Peng Q, Peterson M, et al.
      Pages: 685 - 691
      Abstract: AbstractBackgroundskeletal muscle is the primary site of glucose uptake, yet the impact of age-related changes in muscle strength on diabetes risk is unknown.Methodsfour hundred and twenty-four participants (60% Black, 40% White) from the Michigan site of the Study of Women’s Health Across the Nation contributed annual grip strength measures and were followed from 1996 to 2012 to identify incident cases of diabetes. Diabetes was defined as self-reported physician-diagnosed diabetes, use of anti-diabetic medications or measured fasting glucose ≥126 mg/dl or haemoglobin A1c > 6.5%.Resultsthe 16-year diabetes incidence was 37%. The average baseline weight-normalised grip strength (NGS, kg per kg body weight) was 0.41 ± 0.12 and a mean of 0.29 ± 0.14 kg of absolute grip strength was lost per year. Each 0.1 higher NGS was associated with a 19% lower hazard of incident diabetes (P = 0.006) after adjustment for age, race/ethnicity, economic strain, smoking, menopause status, hormone use, physical activity and waist–hip ratio. In race/ethnic-stratified models, each 0.10 increase in NGS was associated with a 54% lower hazard of incident diabetes (P < 0.0001) among White women but the association among Black women was not statistically significant. In models without adjustment for waist–hip ratio or restricted to women <48 years of age at baseline, there was a statistically significant association between baseline NGS and incident diabetes among Black women. The rate of change in grip strength was not associated with diabetes incidence.Conclusionthe mid-life is an important risk period for diabetes onset. Improving muscle strength. during mid-life may contribute to preventing diabetes among women
      PubDate: Thu, 03 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy067
      Issue No: Vol. 47, No. 5 (2018)
  • An examination of the heterogeneity in the pattern and association between
           rates of change in grip strength and global cognition in late life. A
           multivariate growth mixture modelling approach
    • Authors: Robitaille A; Piccinin A, Hofer S, et al.
      Pages: 692 - 697
      Abstract: AbstractBackgroundprevious research has demonstrated how older adults exhibit different patterns of change in cognitive and physical functioning, suggesting differences in the underlying causal processes.Objectiveto (i) identify subgroups of older adults that best account for different patterns of longitudinal change in performance on global cognition and grip strength, (ii) examine the interrelationship between global cognition and grip strength trajectories within these subgroups and (iii) identify demographic and health-related markers of class membership.Methodsmultivariate growth mixture models (GMM) were used to identify groups of individuals with similar developmental trajectories of muscle strength measured by grip strength, and global cognition measured by Mini Mental State Examination (MMSE).ResultsGMM analyses indicated high, moderate and low functioning groups. Individuals in the high and moderate classes demonstrated better cognitive and physical functioning at the start of the study and less decline than those in the low functioning group. Notably, cognitive performance was related to physical functioning at study entry only among individuals in the low functioning group.Conclusionthe study demonstrates the applicability of the multivariate GMM to achieve a better understanding of the heterogeneity of various aging related processes.
      PubDate: Thu, 05 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy048
      Issue No: Vol. 47, No. 5 (2018)
  • Temporal trends in impairments of physical function among older adults
           during 2001–16 in Sweden: towards a healthier ageing
    • Authors: Santoni G; Angleman S, Ek S, et al.
      Pages: 698 - 704
      Abstract: AbstractBackgrounda trend towards decline in disability has been reported in older adults, but less is known about corresponding temporal trends in measured physical functions.Objectiveto verify these trends during 2001–16 in an older Swedish population.Methodsfunctional status was assessed at three occasions: 2001–04 (n = 2,266), 2007–10 (n = 2,033) and 2013–16 (n = 1,476), using objectively measured balance, chair stands and walking speed. Point prevalence was calculated and trajectories of change in impairment/vital status were assessed and were sex-adjusted and age-stratified: 66; 72; 78; 81 and 84; 87 and 90.Resultspoint prevalence of impairment was significantly lower at the 2013–16 assessment than the 2001–04 in chair stand amongst age cohorts 78–90 years, and in walking speed amongst age cohorts 72–84 years (P < 0.05), but not significantly different for balance. The prevalence remained stable between 2001–04 and 2007–10, while the decrease in chair stands and walking speed primarily occurred between 2007–10 and 2013–16. Among persons unimpaired in 2007–10, the proportion of persons who remained unimpaired in 2013–16 tended to be higher, and both the proportion of persons who became impaired and the proportion of persons who died within 6 years tended to be lower, relative to corresponding proportions for persons unimpaired in 2001–04. Overall, there were no corresponding changes for those starting with impairment.Conclusionsour results suggest a trend towards less functional impairment in older adults in recent years. The improvements appear to be driven by improved prognosis amongst those without impairments rather than substantial changes in prognosis for those with impairments.
      PubDate: Fri, 08 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy085
      Issue No: Vol. 47, No. 5 (2018)
  • Effectiveness and cost-effectiveness of proactive and multidisciplinary
           integrated care for older people with complex problems in general
           practice: an individual participant data meta-analysis
    • Authors: Blom J; Van den Hout W, Den Elzen W, et al.
      Pages: 705 - 714
      Abstract: AbstractPurposeto support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care.Methods designindividual patient data (IPD) meta-analysis of eight clinically controlled trials.Settingprimary care sector.Interventionscombination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified.Main outcomeactivities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up.Secondary outcomesquality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness.Analysisintention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics.Resultsincluded were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%.Conclusioncompared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.
      PubDate: Fri, 22 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy091
      Issue No: Vol. 47, No. 5 (2018)
  • Cardiovascular risk factors and frailty in a cross-sectional study of
           older people: implications for prevention
    • Authors: Wong T; Massa M, O'Halloran A, et al.
      Pages: 714 - 720
      Abstract: AbstractObjectiveto examine the associations of cardiovascular disease (CVD) and cardiovascular risk factors with frailty.Designa cross-sectional study.Settingthe Irish Longitudinal Study on Ageing (TILDA).Participantsfrailty measures were obtained on 5,618 participants and a subset of 4,330 participants with no prior history of CVD.Exposures for observational studycardiovascular risk factors were combined in three composite CVD risk scores (Systematic Coronary Risk Evaluation [SCORE], Ideal Cardiovascular Health [ICH] and Cardiovascular Health Metrics [CHM]).Main outcome measuresa frailty index (40-items) was used to screen for frailty.Methodsthe associations of CVD risk factors with frailty were examined using logistic regression.Resultsoverall, 16.4% of participants had frailty (7.6% at 50–59 years to 42.5% at 80+ years), and the prevalence was higher in those with versus those without prior CVD (43.0% vs. 10.7%). Among those without prior CVD, mean levels of CVD risk factors were closely correlated with higher frailty index scores. Combined CVD risk factors, assessed using SCORE, were linearly and positively associated with frailty. Compared to low-to-moderate SCOREs, the odds ratio (OR) (95% confidence interval, CI) of frailty for those with very high risk was 3.18 (2.38–4.25). Conversely, ICH was linearly and inversely associated with frailty, with an OR for optimal health of 0.29 (0.21–0.40) compared with inadequate health.Conclusionsthe concordant positive associations of SCORE and inverse associations of ICH and CHM with frailty highlight the potential importance of optimum levels of CVD risk factors for prevention of disability in frail older people.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy080
      Issue No: Vol. 47, No. 5 (2018)
  • Is frailty a stable predictor of mortality across time' Evidence from
           the Cognitive Function and Ageing Studies
    • Authors: Mousa A; Savva G, Mitnitski A, et al.
      Pages: 721 - 727
      Abstract: AbstractBackgroundage-specific mortality reduction has been accompanied by a decrease in the prevalence of some diseases and an increase in others. Whether populations are becoming ‘healthier’ depends on which aspect of health is being considered. Frailty has been proposed as an integrative measure to quantify health status.Objectiveto investigate changes in the near-term lethality of frailty before and after a 20-year interval using the frailty index (FI), a summary of age-related health deficit accumulation.Designbaseline data from the Cognitive Function and Ageing Studies (CFAS) in 1991 (n = 7,635) and 2011 (n = 7,762).Settingthree geographically distinct UK centres (Newcastle, Cambridgeshire and Nottingham).Subjectsindividuals aged 65 and over (both institutionalised and community-living).Methodsa 30-item frailty score was used, which includes morbidities, risk factors and subjective measures of disability. Missing items were imputed using multiple imputations by chained equations. Binomial regression was used to investigate the relationship between frailty, age, sex and cohort. Two-year mortality was modelled using logistic regression.Resultsmean frailty was slightly higher in CFAS II (0.19, 95% confidence interval (CI): 0.19–0.20) than CFAS I (0.18, 95% CI: 0.17–0.18). Two-year mortality in CFAS I was higher than in CFAS II (odds ratio (OR) = 1.16, 95% CI: 1.03–1.30). The association between frailty and 2-year mortality was non-linear with an OR of ~1.6 for each 0.10 increment in the FI.Conclusionsthe relationship between frailty and mortality did not significantly differ across the studies. Severe frailty as an indicator of mortality is shown to be a stable construct.
      PubDate: Sat, 16 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy077
      Issue No: Vol. 47, No. 5 (2018)
  • Tracking changes in frailty throughout later life: results from a 17-year
           longitudinal study in the Netherlands
    • Authors: Hoogendijk E; Rockwood K, Theou O, et al.
      Pages: 727 - 733
      Abstract: AbstractBackgroundto better understand the development of frailty with ageing requires longitudinal studies over an extended time period.Objectiveto investigate changes in the degree of frailty during later life, and the extent to which changes are determined by socio-demographic characteristics.Methodssix measurement waves of 1,659 Dutch older adults aged 65 years and over in the Longitudinal Aging Study Amsterdam (LASA) yielded 5,211 observations over 17 years. At each wave, the degree of frailty was measured with a 32-item frailty index (FI), employing the deficit accumulation approach. Socio-demographic characteristics included age, sex, educational level and partner status. Generalized Estimating Equation (GEE) analyses were performed to study longitudinal frailty trajectories.Resultshigher baseline FI scores were observed in older people, women, and those with lower education or without partner. The overall mean FI score at baseline was 0.17, and increased to 0.39 after 17 years. The average doubling time in the number of deficits was 12.6 years, and this was similar in those aged 65–74 years and those aged 75+. Partner status was associated with changes over time in FI score, whereas sex and educational level were not.Conclusionsthis longitudinal study showed that the degree of frailty increased with ageing, faster than the age-related increase previously observed in cross-sectional studies. Even so, the rate of deficit accumulation was relatively stable during later life.
      PubDate: Sat, 19 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy081
      Issue No: Vol. 47, No. 5 (2018)
  • Exploration of older people’s perceptions of behavioural factors
           associated with falls
    • Authors: Robson K; Coyle J, Pope R.
      Pages: 734 - 740
      Abstract: AbstractBackgroundfalls rates in older people continue to rise despite concerted efforts to manage falls risks. As more effective strategies to reduce falls in older people may arise from better understanding their perspectives on falls risk, this study aimed to explore perceptions and behavioural decisions that may affect risk of falling among older people living in regional Australia.Methodthis qualitative research, informed by hermeneutics, explored older people’s perspectives on decisions they made that could affect their falls risk. The study involved 26 participants (21 females) aged 65–84 years, residing in regional Australia. In total, 13 participated in semi-structured focus groups and 13 in semi-structured, in-depth interviews.Resultssix key themes illuminated the challenges older people faced in relation to falls risk. These were: the role that independence played in decision making regarding risk; the influence of previous falls experience; older people’s level of understanding of risks; ability and willingness to engage with support; the need or desire to cover up a fall history; and the influence of finances in managing risk. Older people’s accounts demonstrated they experienced competing influences that impacted upon decisions they made with respect to falls risks. Most significantly, the complex interplay of these influences drove the decisions older people made, sometimes placing them at greater risk of falling.Conclusionconsideration of the multifaceted issues older people face when managing falls risk, and the influence these factors have on their behaviours, is vital to successfully reducing rates of fall related injuries in this population.
      PubDate: Thu, 12 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy051
      Issue No: Vol. 47, No. 5 (2018)
  • Safe working in a 7-day service. Experience of hip fracture care as
           documented by the UK National Hip Fracture Database
    • Authors: Neuburger J; Currie C, Wakeman R, et al.
      Pages: 741 - 745
      Abstract: AbstractObjectiveto describe differences in care and 30-day mortality of patients admitted with hip fracture on weekends (Saturday–Sunday) compared to weekdays (Monday–Friday), and their relationship to the organisation of care.Methodsdata came from the National Hip Fracture Database (NHFD) linked to ONS mortality data on 52,599 patients presenting to 162 units in England between 1 January and 31 December 2014. This was combined with information on geriatrician staffing and major trauma centre (MTC) status. 30-day mortality and care were compared for patients admitted at weekends and weekdays; separately for patients treated in units grouped by the mean level of input by geriatricians, weekend geriatrician clinical cover and MTC status. Differences were adjusted for variation in patients’ characteristics.Resultsthere was no evidence of differences in 30-day mortality between patients admitted at weekends compared to weekdays (7.2 vs 7.5%, P = 0.3) before or after adjusting for patient characteristics in either MTCs or general hospitals. The proportion receiving a preoperative geriatrician assessment was lower at weekends (42.8 vs 60.7%, P < 0.001). 30-day mortality was lower in units with higher levels of geriatrician input, but there was no weekend mortality effect associated with lower levels of input or absence of weekend cover.Conclusionthere was no evidence of a weekend mortality effect among patients treated for hip fracture in the English NHS. It appears that clinical teams provide comparably safe and effective care throughout the week. However, greater geriatrician involvement in teams was associated with overall lower mortality.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy074
      Issue No: Vol. 47, No. 5 (2018)
  • Effectiveness of a multifaceted intervention to reduce night-time sedative
           use in a rehabilitation unit: a pre–post intervention study
    • Authors: Reyes J; Sharkey A, Morrison L, et al.
      Pages: 745 - 748
      Abstract: AbstractBackgroundnight-time sedation prescribed during a hospital stay can result in long-term use of such medications in older people. We examined the effectiveness of a multifaceted intervention to reduce night time sedation in an inpatient rehabilitation unit.Methodsan initial retrospective survey of night-time sedative use was followed by prospective re-evaluation after a number of changes were made including education of staff and of patients regarding the potential hazards of sedative medications, measures to promote sleep hygiene and facilitate a ‘quiet time’ after 10 pm and development of a withdrawal protocol for patients on long-term night sedation. The primary outcome measures were the proportions of patients started on night sedation in the unit and the proportion of those using night sedation where a dose reduction was attempted before and after the intervention.Resultsnight sedation was prescribed for 22/68 (32.4%) subjects in the pre- and 23/169 (13.6%) subjects in the post-intervention surveys (P = 0.001); medication started while in the unit dropped from 10 (14.7%) to 1 (0.6%) (P < 0.0001). There was an improvement in the proportion of patients using night sedation where an attempt was made to reduce the dosage of or eliminate sedative drug use prior to discharge after the intervention was introduced (3/22 (13.6%) vs 14/23 (60.9%) (P = 0.001)).Conclusionsa multifaceted intervention, including ongoing education, audit and feedback and changes to unit practices to promote a ‘quiet time’ at night, leads to a substantial reduction in the use of night sedation in inpatients.
      PubDate: Fri, 11 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy075
      Issue No: Vol. 47, No. 5 (2018)
  • Drug consumption and futile medication prescribing in the last year of
           life: an observational study
    • Authors: Curtin D; O’Mahony D, Gallagher P.
      Pages: 749 - 753
      Abstract: AbstractBackgroundthe last year of life for many older people is associated with high symptom burden and frequent hospitalizations. Hospital physicians have an opportunity to prioritize essential medications and deprescribe potentially futile medications.Objectiveto measure medication consumption during hospitalization in the last year of life and the prevalence of potentially inappropriate medications (PIMs) at hospital discharge.Designretrospective chart review.Settingacute hospital.Subjects≥65 years, hospitalized in the last year of life.Methodsmedication consumption was determined by examining hospital Medication Administration Records. PIMs were defined using STOPPFrail deprescribing criteria.Resultsthe study included 410 patients. The mean age of participants was 80.8, 49.3% were female, and 63.7% were severely frail. The median number of days spent in hospital in the last year of life was 32 (interquartile range 15−59). During all hospitalizations, the mean number of individual medications consumed was 23.8 (standard deviation 10.1). One-in-six patients consumed 35 or more medications in their last year. Over 80% of patients were prescribed at least one PIM at discharge and 33% had ≥3 PIMs. Lipid-lowering medications, proton pump inhibitors, anti-psychotics and calcium supplements accounted for 59% of all PIMs. Full implementation of STOPPFrail recommendations would have resulted in one-in-four long-term medications being discontinued.Conclusionhigh levels of medication consumption in the last year of life not only reflect high symptom burden experienced by patients but also continued prescribing of futile medications. Physicians assisted by the STOPPFrail tool can reduce medication burden for older people approaching end of life.
      PubDate: Mon, 23 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy054
      Issue No: Vol. 47, No. 5 (2018)
  • Two case reports of zoledronic acid-induced uveitis
    • Authors: Kennedy T; Sellar P, Vaideanu-Collins D, et al.
      Pages: 754 - 755
      Abstract: AbstractZoledronic acid (zoledronate) is a bisphosphonate used predominantly as a second-line treatment for post-menopausal osteoporosis. Its administration is associated with an acute phase reaction. Here, we present two cases of anterior uveitis following initial administration of zoledronate. In the first case, an 80-year-old lady presented with right eye pain and decreased visual acuity 24-hours post-infusion. Uveitis was diagnosed and sub-conjunctival injection of corticosteroids was required. In the second case, a 78-year-old lady presented with right eye pain, vomiting and decreased acuity 24-hours after infusion. She was treated with topical steroids and required cataract surgery to normalise visual acuity. Patients prescribed zoledronate should be warned of the risk of ocular side effects and asked to report promptly for treatment if they develop a red, painful eye or blurred vision.
      PubDate: Sat, 28 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy070
      Issue No: Vol. 47, No. 5 (2018)
  • Particulate wear debris osteolysis, acute urinary retention and delirium
           as late complications of hip arthroplasty
    • Authors: Benitez C; Pérez-Jara J, Garcia-Paino L, et al.
      Pages: 756 - 757
      Abstract: AbstractIntrapelvic mass formation as a result of particulate wear debris induced osteolysis is a recognised late complication of cementless total hip arthroplasty. Clinical presentation typically involves hip and/or leg pain resulting in functional impairment, and obstructive urinary symptoms developing 3–20 years after surgery. An acute confusional state has never been described in this scenario. We report the case of an 86-year-old gentleman with a diagnosis of dementia brought to our emergency department with an acute confusional state. Abdominal imaging revealed a distended bladder, a large pelvic mass and a lytic lesion within his right acetabulum. Cytological and microbiological examination of fluid obtained with radiologically guided aspiration of the mass was negative for neoplasia and infection.
      PubDate: Fri, 08 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy083
      Issue No: Vol. 47, No. 5 (2018)
  • A case of undiagnosed pseudohyperkalaemia following a splenectomy
    • Authors: Grech M.
      Pages: 758 - 759
      Abstract: AbstractPseudohyperkalaemia is defined as a rise in serum potassium with concomitantly normal plasma potassium. The case of long undiagnosed pseudohyperkalaemia in an 84-year-old lady with thrombocytosis post splenectomy is presented. Presenting a historical perspective and the multifactorial aetiology of pseudohyperkalaemia the author underlines the importance of detecting apparent hyperkalaemia by testing the plasma potassium. Awareness of the possible causes of pseudohyperkalaemia increases the likelihood of it being detected earlier thereby decreasing the risk of harming the patient. Unnecessary treatment and investigation of pseudohyperkalaemia can cause harm to the patient in the form of undesired side effects, unnecessary investigations and concerns, and potentially dangerous iatrogenically induced cardiac arrhythmias.
      PubDate: Fri, 11 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy076
      Issue No: Vol. 47, No. 5 (2018)
  • An older woman with herpes zoster ophthalmicus complicated by orbital apex
    • Authors: Marie G; Scheffler M.
      Pages: 760 - 760
      Abstract: herpes zoster opthalmicuscomplicationsolder patientsmagnetic resonance imaging (MRI)orbital apex syndromeolder people
      PubDate: Tue, 08 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy073
      Issue No: Vol. 47, No. 5 (2018)
  • Centenarians breaking records: nature or nurture'
    • Authors: Valenzuela P; Morales J, Santos-Lozano A, et al.
      Pages: 761 - 762
      Abstract: ageingtrainingperformanceolder people
      PubDate: Wed, 30 May 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy089
      Issue No: Vol. 47, No. 5 (2018)
  • Internationalisation of Gold Standards Framework use in Primary Health
    • Authors: Teo S; Chong J, Venkatasalu M.
      Pages: 762 - 762
      Abstract: Gold Standards Frameworkprimary caregeneral practicepalliative careolder people
      PubDate: Tue, 10 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ageing/afy100
      Issue No: Vol. 47, No. 5 (2018)
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