elderly patients

Antibiotics for acute diverticulitis

Erin Blanchette — Wed, 02 Apr 2025 21:42:20 +0000

Date Added:

April 2, 2025

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

March 1, 2025

Issue:

Volume:

Pages:

184

URL:

Antibiotics for acute diverticulitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.7103184

Keywords

PMID (1):

40102007

MeSH

Diverticulitis

anti-bacterial agents

Frail Elderly

Colorectal Neoplasms

A concise summary of the evidence regarding treatment of acute diverticulitis with antibiotics. James W. Mold, MD, MPH

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Clinical question: Do antibiotics change clinical outcomes for patients with acute uncomplicated diverticulitis?
Bottom line: For nonseptic immunocompetent patients with acute uncomplicated diverticulitis, antibiotics do not alter early complication or recurrence rates.

Author/s:

Michael R Kolber, Clarence K Wong

Age-Related Cataract Extraction Is Associated With Decreased Falls, Fractures, and Intracranial Hemorrhages in Older Adults

Erin Blanchette — Wed, 19 Mar 2025 21:36:18 +0000

Date Added:

March 19, 2025

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

Wiley

Publication Date:

March 18, 2025

URL:

Journal of the American Geriatrics Society

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.19441

Keywords

age‐related cataracts

cataract extraction

traumatic injury

elderly patients

PMID (1):

40099858

MeSH

Cataract removal appears to reduce falls substantially in older people. James W. Mold, MD, MPH

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Background: Cataract extraction with intraocular lens insertion (CEIOL) is among the most frequently performed surgeries in the United States and is indicated for individuals with age-related cataracts causing visual impairment. The association between CEIOL and falls and hip fractures has been described, but there is a paucity of literature describing the association between CEIOL and various other common morbidity and mortality-increasing age-related traumatic injuries.

Methods: This retrospective cohort study utilized TriNetX, a health database, to access de-identified electronic medical records. Cohorts of patients aged 60 years and older were identified using diagnostic and procedural codes. Cohort 1 was defined as patients with age-related cataracts who underwent CEIOL within 10 years of documented diagnosis of cataracts. Cohort 2 was defined as patients with age-related cataracts who did not undergo CEIOL within 10 years of documented diagnosis of cataracts. Propensity score matching for demographics and other relevant comorbidities was completed. Chi-square analysis was performed, and data were reported as odds ratios with 95% confidence intervals. Outcomes analyzed included proximal humerus fracture, distal radius fracture, hip fracture, ankle fracture, fall, subdural hemorrhage, and epidural hemorrhage.

Results: Patients who underwent CEIOL demonstrated significantly lower odds of falls (p < 0.0001), proximal humerus fracture (p = 0.016), distal radius fracture (p = 0.0004), hip fracture (p < 0.0001), ankle fracture (p = 0.0002), subdural hemorrhage (p < 0.0001), and epidural hemorrhage (p = 0.006) as compared to patients with a documented diagnosis of age-related cataract without CEIOL.

Conclusions: CEIOL was significantly associated with decreased falls and reductions in major fall-related injuries among patients with age-related cataracts. These findings strongly support improved screening protocols to detect vision loss secondary to age-related cataracts, as this may decrease the incidence of common major fall-related injuries among patients with age-related cataracts.

Keywords: age‐related cataracts; cataract extraction; traumatic injury.

Author/s:

Caitlin M Hackl, Brady P Moore, Imanouel M Samai, Brian R Wong

Shorter Dual Antiplatelet Therapy for Older Adults After Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Erin Blanchette — Sun, 31 Mar 2024 22:11:00 +0000

Date Added:

March 31, 2024

Journal/Publication:

JAMA Network Open

Publisher:

American Medical Association

Publication Date:

March 4, 2024

Issue:

Volume:

URL:

Shorter Dual Antiplatelet Therapy for Older Adults After Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2024.4000

Keywords

Cardiology

elderly patients

heart health

dual antiplatelet therapy

PMID (1):

38546647

MeSH

aged

Heart

Data Accuracy

Network Meta-Analysis

Percutaneous Coronary Intervention

Platelet Aggregation Inhibitors* / therapeutic use

It is likely that, in older adults, one to three months of dual antiplatelet therapy following PCI is as effective and safer than six to twelve months of therapy. James W. Mold, MD, MPH

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Importance: The optimal duration of dual antiplatelet therapy (DAPT) for older adults after percutaneous coronary intervention (PCI) is uncertain because they are simultaneously at higher risk for both ischemic and bleeding events.

Objective: To investigate the association of abbreviated DAPT with adverse clinical events among older adults after PCI.

Data sources: The Cochrane Library, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science were searched from inception to August 9, 2023.

Study selection: Randomized clinical trials comparing any 2 of 1, 3, 6, and 12 months of DAPT were included if they reported results for adults aged 65 years or older or 75 years or older.

Data extraction and synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was used to abstract data and assess data quality. Risk ratios for each duration of DAPT were calculated with alternation of the reference group.

Main outcomes and measures: The primary outcome of interest was net adverse clinical events (NACE). Secondary outcomes were major adverse cardiovascular events (MACE) and bleeding.

Results: In 14 randomized clinical trials comprising 19 102 older adults, no differences were observed in the risks of NACE or MACE for 1, 3, 6, and 12 months of DAPT. However, 3 months of DAPT was associated with a lower risk of bleeding compared with 6 months of DAPT (relative risk [RR], 0.50 [95% CI, 0.29-0.84]) and 12 months of DAPT (RR, 0.57 [95% CI, 0.45-0.71]) among older adults. One month of DAPT was also associated with a lower risk of bleeding compared with 6 months of DAPT (RR, 0.68 [95% CI, 0.54-0.86]).

Conclusions and relevance: In this systematic review and meta-analysis of different durations of DAPT for older adults after PCI, an abbreviated DAPT duration was associated with a lower risk of bleeding without any concomitant increase in the risk of MACE or NACE despite the concern for higher-risk coronary anatomy and comorbidities among older adults. This study, which represents the first network meta-analysis of this shortened treatment for older adults, suggests that clinicians may consider abbreviating DAPT for older adults.

Author/s:

Dae Yong Park, Jiun-Ruey Hu, Yasser Jamil, Michelle D Kelsey, W Schuyler Jones, Jennifer Frampton, Ajar Kochar, Wilbert S Aronow, Abdulla A Damluji, Michael G Nanna

Driving Impairment Among Older Adults

Erin Blanchette — Tue, 02 Jan 2024 16:32:24 +0000

Date Added:

January 2, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

December 18, 2023

URL:

Driving Impairment Among Older Adults

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.20347

Keywords

PMID (1):

38109079

MeSH

Distracted Driving

automobile driving

continuous positive airway pressure

Patient and family information on driving safety and older adults. James W. Mold, MD, MPH

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Older drivers may have age-related and medical conditions that affect their driving performance.

More than 90% of car crashes are caused by human error. In older adults, age-related changes of decreased vision, cognitive decline, slowed reaction time, and decreased grip strength increase the risk of common driving errors, including straying from driving lanes, failing to observe speed limits, and overlooking traffic signs.

The risk of dying in a car crash is 2.5 times higher for drivers aged 75 to 79 years and 5 times higher for those aged 80 years or older compared with younger drivers.

Author/s:

Rebecca A Voelker

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Devin Evans — Thu, 21 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

The Journal of the American Medical Association

Publication Date:

January 14, 2021

URL:

APOE ɛ4 Allele Testing and Risk of Alzheimer Disease

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2020.15085

Keywords

PMID (1):

33443531

MeSH

A brief review of the interpretation of APOE tests for diagnosing and predicting dementia of the Alzheimer’s type. James W. Mold, MD, MPH

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A 64-year-old man presented with concern about an abnormal genetic test result for apolipoprotein E (APOE) obtained through his primary care physician. He reported forgetfulness and word-finding difficulties for 3 years but performed all activities of daily living independently and was generally healthy. His father and maternal great aunt developed dementia in their 70s. Physical (including neurologic) examination, basic laboratory studies, and brain magnetic resonance imaging results were normal. The Short Test of Mental Status (STMS) score was 33 (maximal attainable score of 38 indicates best performance). Neuropsychological assessment showed average to above-average performance in all cognitive domains, accounting for age and education. Results of his genetic testing for APOE were reported as follows: “This individual possesses an apolipoprotein E genotype (3 and 4) that indicates, with high specificity, that Alzheimer’s disease is the cause of or a contributor to the observed dementia.”

Author/s:

Choudhury, Parichita, Ramanan, Vijay K., Boeve, Bradley F.

Polypharmacy Management in Older Patients

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

Mayo Clinic Proceedings

Publication Date:

January 5, 2021

Issue:

Volume:

Pages:

242-256

URL:

Polypharmacy Management in Older Patients

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.06.012

Keywords

PMID (1):

33413822

MeSH

A nice summary of the hazards, prevention, and management of polypharmacy in the elderly. James W. Mold, MD, MPH

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Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed "polypharmacy." This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems. To reduce polypharmacy, we delineate a systematic, consultative approach to identify highest-risk medications and drug-therapy problems. We address strategic reductions (deprescribing) of medications in palliative care, long-term care, and ambulatory older adults. Best practices for reducing opioids, benzodiazepines, and other high-risk medications include education about risk and agreement by patients and their families, advocates, and care teams. Addressing deprescribing should be within the framework of patients' health status as their care and goals transition from longevity to a plan of maintaining alertness, comfort, and satisfaction of quality of life. A team approach to address polypharmacy and avoidance of high-risk therapy is optimal within long-term care. Patients with terminal illnesses or those moving toward a comfort-care emphasis benefit from medication adjustments that are recognized beneficially within each patient's care goals. In caring for older adults, the acknowledgement that complicated regimens and high-risk medications requires a care plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.

Author/s:

Hoel, Robert W., Giddings-Connolly, Ryan M., Takahashi, Paul Y.

Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults

Brian Desmarais — Sat, 07 Nov 2020 21:37:46 +0000

Date Added:

January 21, 2021

Journal/Publication:

U.S. Department of Health and Human Services

Publication Date:

November 3, 2020

URL:

Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

MeSH

analgesics, non-narcotic

opioid-related disorders

Prescription Drug Monitoring Programs

analgesics, opioid

An AHRQ evidence review on the prevention, diagnosis, and management of opioid misuse. James W. Mold, MD, MPH

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Structured Abstract

Background. Opioid-related harms are increasing among older adults. Until we better understand the factors contributing to this trend, we will be unable to design and implement effective interventions to optimally manage opioid use and its potential harms among older adults. Although considerable research has been done in younger or mixed-age populations, the degree to which it is directly applicable to older adults is uncertain.

Objectives. To provide a framework for understanding how to reduce adverse outcomes of opioid use among older adults, and to describe the evidence available for different factors associated with and interventions to reduce adverse outcomes related to opioid use in this population.

Approach. With input from a diverse panel of content experts and other stakeholders, we developed a conceptual framework and evidence map to characterize empirical studies of factors associated with opioid-related outcomes and interventions to reduce opioid-related harms in older adults. We identified relevant literature among older adults (age ≥60 years) for an evidence map by systematically searching PubMed, PsycINFO, and CINAHL for studies published in English between 2000 and May 6, 2020.

Findings. We identified 5,933 citations, from which we identified 41 studies with multivariable models of factors associated with opioid-related outcomes and 16 studies of interventions in older adults. More than half (22/41) of the multivariable analysis studies evaluated factors associated with long-term opioid use (which, though not a harm per se, may increase the risk of harms if not appropriately managed). Prior or early postoperative opioid use, or greater amounts of prescribed opioids (high number of opioid prescriptions or higher opioid dose), were consistently (100% agreement) and strongly (measure of association ≥2.0) associated with long-term opioid use. Back pain, depression, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs), and fibromyalgia also had consistent, but weaker, associations with long-term opioid use. Several factors were mostly associated (>75% agreement) with long-term opioid use, including benzodiazepine use, comorbidity scores, (generally undefined) substance misuse, tobacco use, and low income. However, studies were mostly consistent that alcohol abuse and healthcare utilization were not associated with long-term opioid use. Gender, age among older adults, Black race, dementia, rural/nonurban residence, prescription of long-acting opioids, unmarried status, and use of muscle relaxants were variably associated (<75% agreement) with long-term opioid use.

Six studies examined factors associated with opioid-related disorders, although only one study evaluated factors associated with opioid use disorder. Alcohol misuse and gender were variably associated with opioid misuse (examined by three studies each).

All other evaluations of specific pairs of associated factors and outcomes of interest were evaluated by only one or two studies each. These included analyses of factors associated with multiple opioid prescribers, mental health outcomes, physical health outcomes, all-cause hospitalization, opioid-related hospitalization, nonopioid-specific hospitalization, emergency department visits, opioid overdose, all-cause death, opioid-related death, and nonopioid-related death.

The evidence on interventions directed at older adults is sparse. Of the 16 studies of opioid-related interventions in older adults, six examined screening tools to predict opioid-related harms, but none of these tools was tested in clinical practice to assess real-world results. Two studies found that prescription drug monitoring programs are associated with less opioid use in communities. Other studied interventions include multidisciplinary pain education for patients, an educational pamphlet for patients, implementation of an opioid safety initiative, provision of patient information and pain management training for clinicians, a bundle of educational modalities for clinicians, free prescription acetaminophen, a nationally mandated tamper-resistant opioid formulation, and motivational interview training for nursing students. Few intervention studies evaluated pain or other patient-centered outcomes such as disability and functioning.

Conclusions. The evidence base that is directly applicable to older adults who are prescribed opioids or have opioid-related disorders is limited. Fundamental research is necessary to determine which factors may predict clinically important, patient-centered, opioid-related outcomes. Studies to date have identified numerous possible factors associated with long-term opioid use (whether appropriate or not), but analyses of other opioid-related outcomes in older adults are relatively sparse. Research is also needed to identify interventions to reduce opioid prescribing where harms outweigh benefits (including screening tools), reduce opioid-related harms and disorders, and treat existing misuse or opioid use disorder among older adults.

Author/s:

Agency for Healthcare Research and Quality

Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis

Jeffrey Wilson — Sun, 03 Feb 2019 21:10:18 +0000

Date Added:

February 3, 2019

Journal/Publication:

Age and Aging

Publisher:

Oxford University Press

Publication Date:

January 7, 2019

URL:

Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis.

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1093/ageing/afy189

Keywords

podiatric intervention

fall risk

elderly patients

podiatry

PMID (1):

30615052

MeSH

podiatry

ankle

This meta-analysis found that podiatric interventions reduced fall risk in older patients.

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BACKGROUND:

foot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes.

METHODS:

systematic review and meta-analysis. We searched multiple electronic databases with no language restrictions. Randomised or quasi-randomised-controlled trials documenting podiatry interventions in older people (aged 60+) were included. Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane Risk of Bias tool. TiDieR guidelines guided data extraction and where suitable statistical summary data were available, we combined the selected outcome data in pooled meta-analyses.

RESULTS:

from 35,857 titles and 5,201 screened abstracts, nine studies involving 6,502 participants (range 40-3,727) met the inclusion criteria. Interventions were single component podiatry (two studies), multifaceted podiatry (three studies), or multifactorial involving other components and referral to podiatry component (four studies). Seven studies were conducted in the community and two in care homes. Quality assessment showed overall low risk for selection bias, but unclear or high risk of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate.

CONCLUSIONS:

Multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data.

Author/s:

Wylie, Gavin, Torrens, Claire, Campbell, Pauline, Frost, Helen, Gordon, Adam Lee, Menz, Hylton B, Skelton, Dawn A, Sullivan, Frank, Witham, Miles D, Morris, Jacque

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial

Tracy Ashby — Mon, 07 Jan 2019 06:00:00 +0000

Date Added:

January 21, 2021

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 6, 2018

Issue:

Volume:

319

Pages:

872-882

URL:

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2018.0899

Keywords

PMID (1):

29509867

MeSH

Analgesics

analgesics, opioid

analgesics, non-narcotic

chronic pain

osteoarthritis, knee

In this RCT, comparing non-opioids to opioids for management of chronic pain in the lower back or knee due to OA the researchers found that non-opioid medications were more effective for relieving pain with fewer side effects.

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Importance Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

Objective To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.

Design, Setting, and Participants Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized.

Interventions Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

Main Outcomes and Measures The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19).

Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Trial Registration clinicaltrials.gov Identifier: NCT01583985

Author/s:

Krebs, Erin E., Gravely, Amy, Nugent, Sean, Jensen, Agnes C., DeRonne, Beth, Goldsmith, Elizabeth S., Kroenke, Kurt, Bair, Matthew J, Noorbaloochi, Siamak