life expectancy

The goal of hospice is to provide compassionate care to maximize a person’s comfort and quality of life during the natural dying process. Hospice care teams are composed of doctors, nurses, social workers, chaplains, and other individuals who work together to address the physical, emotional, social, and spiritual needs of people with a terminal illness and to support their families. This generally includes alleviating symptoms (such as pain, shortness of breath, or anxiety), establishing a comfortable and peaceful environment, and facilitating meaningful time with loved ones.

Author/s:

Vanessa Wagner, Adam Marks

A GUIDE to help patients and families better understand serious illnesses: Mnemonic device provides way to teach learners about advance care planning

Erin Blanchette — Sun, 04 Feb 2024 22:49:57 +0000

Date Added:

February 4, 2024

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

January 1, 2024

Issue:

Volume:

Pages:

68-70

URL:

A GUIDE to help patients and families better understand serious illnesses: Mnemonic device provides way to teach learners about advance care planning

Type:

Clinical Decision Aids, Best Local Practices

Format:

Article

DOI (1):

10.46747/cfp.700168

Keywords

advance care planning

PMID (1):

38262750

MeSH

Advance Care Planning

patients

terminal care

Cardiopulmonary Resuscitation

life expectancy

anxiety

Explanation of how to use illness trajectory graphs to guide advance care planning in people with serious illnesses. James W. Mold, MD, MPH

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Advance care planning (ACP) was identified as a priority in the 2006 final report of the Public Information and Awareness Working Group of the Canadian Strategy on Palliative and End-of-Life Care.1 An important component of ACP is patients’ understanding of their prognoses, which might include expectations related to future function, symptoms, and life expectancy.2-4 Without realistic prognostic information, patients are at risk of not engaging in ACP that would otherwise help them gain control over their illnesses, reduce anxiety, and avoid unwanted treatments.2,3,5 Moreover, lack of that information might lead to challenging downstream goals-of-care conversations. In guidance published in 2023 regarding a physician’s duty to discuss a patient’s medical condition and prognosis during a goals-of-care discussion when the physician deems cardiopulmonary resuscitation not to be indicated, the College of Physicians and Surgeons of Ontario highlighted the importance of physicians being able to communicate prognoses skillfully.6

Author/s:

Helen James, Warren Harris Lewin

Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents — Selected U.S. States, 2019

Aubrey Delammermore — Sat, 24 Sep 2022 05:00:00 +0000

Date Added:

September 24, 2022

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

US Department of Health and Human Services

Publication Date:

September 20, 2022

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm7139e1

Keywords

MeSH

Patient Acceptance of Health Care

Recommendations from the CDC regarding prevention of complications children with sickle cell anemia. James W. Mold, MD, MPH

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Introduction: Sickle cell disease (SCD), a group of inherited blood cell disorders that primarily affects Black or African American persons, is associated with severe complications and a >20-year reduction in life expectancy. In 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with the most severe SCD subtypes, known as sickle cell anemia (SCA); recommendations included 1) annual screening of children and adolescents aged 2–16 years with transcranial Doppler (TCD) ultrasound to identify those at risk for stroke and 2) offering hydroxyurea therapy to children and adolescents aged ≥9 months to reduce the risk for several life-threatening complications.

Methods: Data from the IBM MarketScan Multi-State Medicaid Database were analyzed. TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2–16 years and continuously enrolled in Medicaid during 2019. Percentage change during 2014–2019 and variation by health subgroups were assessed. Analyses were stratified by age.

Results: During 2014–2019, TCD screening increased 27% among children and adolescents aged 10–16 years; hydroxyurea use increased 27% among children aged 2–9 years and 23% among children and adolescents aged 10–16 years. However, in 2019, only 47% and 38% of children and adolescents aged 2–9 and 10–16 years, respectively, had received TCD screening and 38% and 53% of children and adolescents aged 2–9 years and 10–16 years, respectively, used hydroxyurea. For both prevention strategies, usage was highest among children and adolescents with high levels of health care utilization and evidence of previous complications indicative of severe disease.

Conclusion and Implications for Public Health Practice: Despite increases since 2014, TCD screening and hydroxyurea use remain low among children and adolescents with SCA. Health care providers should implement quality care strategies within their clinics and partner with patients, families, and community-based organizations to address barriers to delivering and receiving recommended care.

Author/s:

Schieve, L. A., Simmons, G. M., Payne, A. B., Abe, K., Hsu, L. L., Hulihan, M., Pope, S., Rhie, S., Dupervil, B., Hooper, W. C.

Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement

Devin Evans — Wed, 24 Mar 2021 05:00:00 +0000

Date Added:

March 24, 2021

Journal/Publication:

Journal of the American Medical Association

Publication Date:

March 9, 2021

Issue:

Volume:

325

Pages:

962-970

URL:

Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.1117

Keywords

tobacco

smoking

Cancer Screeing

PMID (1):

33687470

MeSH

smoke

Tobacco Smoke Pollution

early detection of cancer

Updated USPSTF recommendation regarding screening for lung cancer. James W. Mold, MD, MPH

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Importance: Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.

Objective: To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models.

Population: This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

Evidence assessment: The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.

Recommendation: The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

Author/s:

US Preventive Services Task Force

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Brian Desmarais — Thu, 22 Oct 2020 14:30:11 +0000

Date Added:

October 22, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

October 20, 2020

Issue:

Volume:

324

Pages:

1543-1556

URL:

Medical Care of Adults With Down Syndrome: A Clinical Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1001/jama.2020.17024

MeSH

cardiovascular diseases

Patient Advocacy

comorbidity

Abstracting and Indexing

A guideline for the medical care of adults with Down’s Syndrome (see Results section). James W. Mold,. MD, MPH

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Abstract

Importance: Down syndrome is the most common chromosomal condition, and average life expectancy has increased substantially, from 25 years in 1983 to 60 years in 2020. Despite the unique clinical comorbidities among adults with Down syndrome, there are no clinical guidelines for the care of these patients.

Objective: To develop an evidence-based clinical practice guideline for adults with Down syndrome.

Evidence review: The Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup (n = 13) developed 10 Population/Intervention/ Comparison/Outcome (PICO) questions for adults with Down syndrome addressing multiple clinical areas including mental health (2 questions), dementia, screening or treatment of diabetes, cardiovascular disease, obesity, osteoporosis, atlantoaxial instability, thyroid disease, and celiac disease. These questions guided the literature search in MEDLINE, EMBASE, PubMed, PsychINFO, Cochrane Library, and the TRIP Database, searched from January 1, 2000, to February 26, 2018, with an updated search through August 6, 2020. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework, in January 2019, the 13-member Workgroup and 16 additional clinical and scientific experts, nurses, patient representatives, and a methodologist developed clinical recommendations. A statement of good practice was made when there was a high level of certainty that the recommendation would do more good than harm, but there was little direct evidence.

Findings: From 11 295 literature citations associated with 10 PICO questions, 20 relevant studies were identified. An updated search identified 2 additional studies, for a total of 22 included studies (3 systematic reviews, 19 primary studies), which were reviewed and synthesized. Based on this analysis, 14 recommendations and 4 statements of good practice were developed. Overall, the evidence base was limited. Only 1 strong recommendation was formulated: screening for Alzheimer-type dementia starting at age 40 years. Four recommendations (managing risk factors for cardiovascular disease and stroke prevention, screening for obesity, and evaluation for secondary causes of osteoporosis) agreed with existing guidance for individuals without Down syndrome. Two recommendations for diabetes screening recommend earlier initiation of screening and at shorter intervals given the high prevalence and earlier onset in adults with Down syndrome.

Conclusions and relevance: These evidence-based clinical guidelines provide recommendations to support primary care of adults with Down syndrome. The lack of high-quality evidence limits the strength of the recommendations and highlights the need for additional research.

Author/s:

Tsou, Amy Y., Bulova, Peter, Capone, George, Chicoine, Brian, Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Devin Evans — Thu, 15 Oct 2020 05:00:00 +0000

Date Added:

October 15, 2020

Journal/Publication:

The New England Journal of Medicine

Publication Date:

October 15, 2020

Issue:

383

Pages:

1535-1543

URL:

Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2002449

Keywords

MeSH

cardiovascular diseases

bariatric surgery

In this relatively large, long term Swedish RCT, obese patients treated with bariatric surgery lived 3 years longer on average than those treated medically. Unfortunately, only the abstract can be made available through RPR. James W. Mold, MD, MPH

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BACKGROUND

Obesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear.

METHODS

We used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population.

RESULTS

In total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.

CONCLUSIONS

Among patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population.

Author/s:

Carlsson, Lena M.S., Sjöholm, Kajsa, Jacobson, Peter, Andersson-Assarsson, Johanna C., Svensson, Per-Arne, Taube, Magdalena, Carlsson, Björn, Peltonen, Markku

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Brian Desmarais — Fri, 03 Jan 2020 19:11:46 +0000

Date Added:

January 3, 2020

Journal/Publication:

The Mayo Clinic Proceedings

Publication Date:

January 1, 2020

Issue:

Volume:

Pages:

184–196

URL:

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocp.2019.02.021

Keywords

MeSH

A fair and balanced review of CRC screening in older people from Mayo. James W. Mold, MD, MPH

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Colorectal cancer (CRC) is the fourth leading cause of cancer and second leading cause of mortality from cancer in the United States. As the population ages, decisions regarding the initiation and cessation of screening and surveillance for CRC are of increasing importance. In elderly patients, the risks of CRC and the presenting signs and symptoms are similar to those in younger patients. Screening and ongoing surveillance should be considered in patients who have a life expectancy of 10 years or more. Life expectancy estimates can be calculated using online calculators. If screening is deemed appropriate, the choice of which test to use first is unclear. Currently, there are a number of modalities available to screen for CRC, including both invasive modalities (eg, colonoscopy, sigmoidoscopy, capsule colonoscopy, and computed tomographic colonography) and noninvasive modalities (fecal immunochemical test, stool DNA testing, and blood testing). Colonoscopy and other invasive testing options are considered safe, but the risks of complications of the bowel preparation, the procedure, and sedation medications are all increased in older patients. In contrast, noninvasive testing provides a safe initial test; however, it is important to consider the increased false-positive rates in the elderly, and a positive test result will usually necessitate colonoscopy to establish the diagnosis. Ongoing screening and surveillance should be a shared decision-making process with the patient based on multiple factors including the patient’s morbidity and mortality risk from CRC and his or her underlying comorbidities, the patient’s functional status, and the patient’s preferences for screening. Ultimately, the decision to initiate or discontinue screening for CRC in older patients should be done based on a case-by-case individualized discussion.

Author/s:

Nee, J., Chippendale, R. Z., Feuerstein, J.D.

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Brian Desmarais — Thu, 07 Nov 2019 15:39:51 +0000

Date Added:

November 7, 2019

Journal/Publication:

Annals of Internal Medicine

Publication Date:

November 5, 2019

Issue:

Volume:

171

Pages:

643-654

URL:

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0642

Keywords

Colonoscopy

Early Detection of Cancer

MeSH

early detection of cancer

2019 CRC screening guideline for average risk adults. James W. Mold, MD, MPH

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DESCRIPTION:

The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults.

METHODS:

This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.

TARGET AUDIENCE AND PATIENT POPULATION:

The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer.

GUIDANCE STATEMENT 1:

Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

GUIDANCE STATEMENT 2:

Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.

GUIDANCE STATEMENT 3:

Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.

Author/s:

Qaseem, A., Crandall, C.J., Mustafa, R.A., Hicks, L.A., Wilt, T.J., Clinical Guidelines Committee of the American College of Physicians

Hip Fractures in Older Adults in 2019

Tracy Ashby — Mon, 13 May 2019 05:00:00 +0000

Date Added:

May 13, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

May 10, 2019

URL:

Hip Fractures in Older Adults in 2019

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.5453

Keywords

hip fractures

osteoporosis

PMID (1):

31074763

MeSH

osteoporotic fractures

osteoporosis

life expectancy

frailty

A concise, patient-centric review of hip fracture prevention in older patients. James W., Mold, MD, MPH

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The incidence of osteoporotic fracture increases exponentially throughout life, as does the risk of the devastating consequences of these fractures, including functional decline, institutionalization, mortality, and destitution.1 Adults in their eighth and ninth decades of life are less likely to be screened and treated for osteoporosis than younger individuals. Guidelines for pharmacologic treatment suggest using 10-year fracture risk estimations, but they do not address decision making for patients with life expectancies less than 10 years. Further, existing fracture risk calculators do not include many comorbidities or frailty characteristics common in older adults that influence risk-benefit assessment when considering pharmacologic treatment as a preventive measure for osteoporosis.

An approach to fracture prevention in older community-dwelling adults is reviewed, including an estimation of fracture risk and life expectancy, shared decision making for pharmacologic interventions, and important nonpharmacologic prevention strategies.

Author/s:

Berry, Sarah D., Kiel, Douglas P., Colón-Emeric, Cathleen

Health Benefits of Smoking Cessation

Jeffrey Wilson — Sat, 16 Feb 2019 22:50:25 +0000

Date Added:

February 16, 2019

Journal/Publication:

Tobacco Free Initiative

Publisher:

World Health Organization

URL:

Fact sheet about health benefits of smoking cessation

Type:

Patient Education Materials

Format:

Article

Keywords

MeSH

A nice fact sheet from the WHO to encourage your patients to quit smoking.

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There are immediate and long-term health benefits of quitting for all smokers.

Beneficial health changes that take place:

Within 20 minutes, your heart rate and blood pressure drop.
12 hours, the carbon monoxide level in your blood drops to normal.
2-12 weeks, your circulation improves and your lung function increases.
1-9 months, coughing and shortness of breath decrease.
1 year, your risk of coronary heart disease is about half that of a smoker's.
5 years, your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
10 years, your risk of lung cancer falls to about half that of a smoker and your risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.
15 years, the risk of coronary heart disease is that of a nonsmoker's.

Author/s:

World Health Organization

The Mediterranean Diet: What You Need to Know About Eating the Mediterranean Way

Tracy Ashby — Fri, 02 Nov 2018 05:00:00 +0000

Date Added:

November 2, 2018

Publisher:

HelpGuide.org

Publication Date:

September 1, 2018

URL:

The Mediterranean Diet: What You Need to Know About Eating the Mediterranean Way

Type:

Patient Education Materials

Format:

Article

Keywords

MeSH

This is an explanation of the Mediterranean Diet.

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When you think about Mediterranean food, your mind may go to pizza and pasta from Italy, or lamb chops from Greece, but these dishes don’t fit into the healthy dietary plans advertised as “Mediterranean.” A true Mediterranean diet consists mainly of fruits and vegetables, seafood, olive oil, hearty grains, and other foods that help fight against heart disease, certain cancers, diabetes, and cognitive decline. It’s a diet worth chasing; making the switch from pepperoni and pasta to fish and avocados may take some effort, but you could soon be on a path to a healthier and longer life.

Author/s:

Smith, Melinda, Segal, Robert