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OA Elderly Medicine
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This is an Open Access Journal

Open Access journal
ISSN (Online) 2054-734X
Published by OA Publishing London

[37 journals]

Evidence-based strategies to reduce polypharmacy: A review.
- Abstract: Polypharmacy, a preventable and significant contributor to morbidity and mortality in the geriatric population, is best defined as any number of medications that exceed medical necessity. A multi-pronged approach using evidence-based interventions is needed to effectively address polypharmacy and prevent downstream harm to patients. Resources and interventions should target patients, situations, and prescribing practices associated with higher risk of experiencing an adverse drug event. Liberalizing clinical targets in the elderly and drawing from palliative care concepts can pave the way for rational discontinuation of multiple medications. Many of these strategies are employed by interdisciplinary teams and models of care that have proven to be effective in minimizing polypharmacy. This review summarizes evidence-based strategies for addressing polypharmacy and reducing medication-related problems in vulnerable populations such as the elderly.
  PubDate: 11/18/2014 07:34:25 am
Aortic stenosis and aging.
- Abstract: Introduction Aortic stenosis (AS) develops when the effective area of valve opening becomes progressively narrow. In the elderly population, it is most frequently due to calcification. It is a common disease with an estimated prevalence of 2% in those 65 years and above. Without intervention, the prognosis is poor with more than 50% two year mortality once symptoms developed. The new ACC/AHA guidelines classifies AS into: patients at risk of aortic stenosis (stage A), with progressive haemodynamic obstruction (stage B), severe asymptomatic (stage C) and severe symptomatic aortic stenosis (stage D). Once symptoms develop, treatment is generally recommended. For patients with estimated low to intermediate operative risk, surgical aortic valve replacement is the current standard treatment. Transcatheter aortic valve intervention (TAVI) has developed as an effective and comparable alternative to surgical aortic valve replacement in patients who have high or prohibitive operative risk. Compared to conservative therapy, it improves symptoms and functional status, and reduces mortality by 20% at one year. However, it has increased vascular complications, stroke and major bleeding. The decision making of who should receive TAVI is a complex one and requires meticulous assessment of operative risks, procedural suitability, comorbidities, life expectancy and frailty. The long term durability and safety is still being evaluated. Conservative management includes a holistic approach in patient and family counselling, symptoms management with medications or valvuloplasty and palliative service involvement. Conclusion Aortic stenosis has a huge disease burden in the elderly population. The development of TAVI offers an effective alternative to patients who have excessive operative risk. Patient selection is the key for a successful TAVI. Such complex decision making should ideally be carried out by a multidisciplinary specialist team. Conservative management remains a suitable option for patients who are too ill and too frail.
  PubDate: 11/18/2014 07:34:25 am
Pharmacokinetics and pharmacodynamics in the elderly.
- Abstract: Pharmacotherapy in the elderly is one of the most challenging aspects of patient care. It is important to understand the pharmacologic properties of drugs in elderly patients. Different parts of pharmacokinetics such as distribution, metabolism and renal elimination are affected by age. Renal elimination may be measured or estimated (eGFR) whereas other changes are difficult to measure. Pharmacodynamic changes with aging affect both beneficial and adverse effects in most organs. These age-related changes make elderly patients at greater risk of adverse drug effects. Adjustment in choice of drugs and dosage is advisable. Starting at a low dose and titrating slowly followed by careful evaluation of effects may minimize the risk of adverse effects. It is important to choose the lowest dose required for clinical effect.
  PubDate: 04/14/2014 10:15:02 pm
Gout in the elderly.
- Abstract: Gout is result of deposition of monosodium urate crystals in and around joints and soft tissues, due to low solubility of uric acid in hyperuricemic states, it is associated with significant morbidity and mortality form both intra and extra articular complications. There is an increased incidence of gout in the elderly, with the clinical picture differing somewhat from middle age. Additionally, complications may be more severe. The management of gout may be more challenging in the elderly, due to medical co morbidities, deteriorating metabolic function and drug interactions due to polypharmacy. This review discusses gout and its management in general, with a focus on the presentation and management issues that arise in the elderly.
  PubDate: 04/14/2014 10:15:02 pm
Assessment of outcome in clinical trials in mild Alzheimer’s disease:
Urgent time for a rethink'
- Abstract: A major barrier for clinical trials in AD is the lack of sensitive clinical endpoints for the early stages. Until recently, regulatory agencies have required demonstration of improvement in two disease domains, cognition plus functional or global status, as evidence of symptomatic improvement during clinical trials for AD. However, the model of Alzheimer’s disease progression indicates impairment in cognition occurs earlier than changes in function, and new draft guidance from the FDA considers change in cognition as an endpoint. The Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog) is the most widely used assessment of cognition in clinical trials; however, analysis of its psychometric properties, show it lacks the sensitivity to detect change in cognition in mild AD. There is a need to develop a new outcome measure capable of capturing the subtle changes associated with mild AD in a reliable and valid way. Given the heterogeneity of AD phenotypes, development of a reliable, valid and clinically meaningful outcome measure is complex and challenging and will require discussion and co-operation between researchers, clinicians, industry, and patients and their advocates to achieve success.
  PubDate: 04/14/2014 10:15:02 pm
Chronic pain in the elderly.
- Abstract: Chronic pain in the elderly is frequent, often underecognized and undertreated, resulting in poor quality of life. Because of the ageing population in the developed world, it represents a growing problem, with substantial socioeconomic consequences. Apart from often being multifactorial, its treatment is complicated by co-morbidities and increased susceptibility to medical side effects. Effective pain relief may require a multidisciplinary approach and non-pharmacologic therapies. This review aims to address the critical aspects of the causes, recognition and treatment of chronic pain in the elderly.
  PubDate: 04/14/2014 10:15:02 pm
Obesity in the older adult.
- Abstract: Our population is aging and along with this increase in the number of older adults, the prevalence of obesity parallels this rise. This has a number of potential public health concerns in that obesity affects not only cardiovascular risk factors and mortality, but in older adults impacts function and disability. There are very few randomized controlled trials in older adults. This review will outline some of the evidence available in older adults and demonstrate their outcomes. Additionally, we will explore some of the issues revolving around bariatric surgery in older adults and present evidence and controversies noting that it potentially may be a suitable alternative to lifestyle measures.
  PubDate: 04/14/2014 10:15:02 pm