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multimorbidity older persons

Amanda H Lavan, Denis O'Mahony, Paul Gallagher, Richard Fordham, Evelyn Flanagan, Darren Dahly, Stephen Byrne, Mirko Petrovic, Adalsteinn Gudmundsson, Olafur Samuelsson, Antonio Cherubini, Alfonso J Cruz-Jentoft, Roy L Soiza, Joseph A Eustace
BACKGROUND: The aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients' current prescriptions by applying the published STOPP and START criteria, highlighting drug-drug and drug-disease interactions and providing non-pharmacological recommendations aimed at reducing the risk of incident delirium. METHODS: We will conduct a multinational, pragmatic, parallel arm Prospective Randomized Open-label, Blinded Endpoint (PROBE) controlled trial...
February 13, 2019: BMC Geriatrics
Silvan Licher, Alis Heshmatollah, Kimberly D van der Willik, Bruno H Ch Stricker, Rikje Ruiter, Emmely W de Roos, Lies Lahousse, Peter J Koudstaal, Albert Hofman, Lana Fani, Guy G O Brusselle, Daniel Bos, Banafsheh Arshi, Maryam Kavousi, Maarten J G Leening, M Kamran Ikram, M Arfan Ikram
BACKGROUND: Non-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk. METHODS AND FINDINGS: Between July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterdam Study aged 45 years and older who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease...
February 2019: PLoS Medicine
Terri R Fried, Marcia C Mecca
Older adults are prescribed a growing number of medications. Polypharmacy, commonly considered the receipt of five or more medications, is associated with a range of adverse outcomes. There is a debate about the reason(s) why. On one side is the assertion that older persons are being prescribed too many medications, with the number of medications increasing the risk of adverse events. On the other side is the observation that polypharmacy is associated both with overprescribing of inappropriate medications and underprescribing of appropriate medications...
January 30, 2019: Journal of the American Geriatrics Society
Marte Sofie Wang-Hansen, Torgeir Bruun Wyller, Lara T Hvidsten, Hege Kersten
PURPOSE: The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. METHODS: Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital...
January 20, 2019: European Journal of Clinical Pharmacology
Giola Santoni, Bettina Meinow, Anders Wimo, Alessandra Marengoni, Laura Fratiglioni, Amaia Calderón-Larrañaga
OBJECTIVES: To describe the use of social and medical care services in a community-dwelling older population from Stockholm, Sweden, using an integrated clinical and functional assessment tool. DESIGN: Study based on data from the longitudinal community-based Swedish National Study on Aging and Care in Kungsholmen. SETTING AND PARTICIPANTS: Random sample of people >65 years of age living in the community in central Stockholm between March 2001 and June 2004 (N = 2368)...
January 17, 2019: Journal of the American Medical Directors Association
Huijin Lau, Suzana Shahar, Norlela Hussin, Mohd Za Kamarudin, Tengku At Hamid, Siti Z-Ms Mukari, Nor F Rajab, Normah C Din, Azahadi Omar, Devinder Ka Singh, Hasnah Haron, Razinah Sharif, Hanis M Yahya, Arimi Fitri, Zahara A Manaf, Zainora Mohammed, Wan S Ishak
AIM: The 36-month Long-Term Research Grant Scheme project: Towards Usual Aging - Neuroprotective Model for Healthy Longevity among Malaysian Elderly was designed to address multidimensional aspects including psychosocial, biophysical health, nutrition and dietary pattern, and auditory and visual function to highlight the magnitude of these associations in a single study. METHODS: A total of 2322 respondents aged ≥60 years were recruited at baseline using the multistage sampling method, followed up at 18 months and 36 months...
January 7, 2019: Geriatrics & Gerontology International
Silvia Netti Tiozzo, Cristina Basso, Giulia Capodaglio, Elena Schievano, Matilde Dotto, Francesco Avossa, Ugo Fedeli, Maria Chiara Corti
BACKGROUND: The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and emergency room (ER) visits. AIMS: The study aims to describe the impact of a care management program (CMP) developed in the Veneto region (Northeastern Italy) for patients affected by chronic heart failure (CHF) and multimorbidity. METHODS: The CMP was provided to 330 patients > 65 years suffering from CHF and multimorbidity...
January 7, 2019: Aging Clinical and Experimental Research
Janet Sultana, Ingrid Leal, Marcel de Wilde, Maria de Ridder, Johan van der Lei, Miriam Sturkenboom, Gianluca Trifiro'
INTRODUCTION: The role of frailty in postmarketing drug safety is increasingly acknowledged. Few European electronic medical records (EMRs) have been used to explore frailty in observational drug safety research. OBJECTIVE: The aim of this study was to identify data elements, beyond multimorbidity and polypharmacy, that could potentially contribute to measuring frailty among older adults in the Dutch nationwide Integrated Primary Care Information (IPCI) database...
January 8, 2019: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Phoebe Ullrich, Tobias Eckert, Martin Bongartz, Christian Werner, Rainer Kiss, Jürgen M Bauer, Klaus Hauer
OBJECTIVES: To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. METHODS: A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17-26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI)...
December 27, 2018: Archives of Gerontology and Geriatrics
Francisco T T Lai, Samuel Y S Wong, Benjamin H K Yip, Bruce Guthrie, Stewart W Mercer, Roger Y Chung, Gary K K Chung, Patsy Y K Chau, Eliza L Y Wong, Jean Woo, Eng-Kiong Yeoh
BACKGROUND: Previous research has suggested a differential short-term effect of multimorbidity on hospitalization by age, with younger groups affected more. This study compares the nine-year hospitalization pattern by age and multimorbidity status in a retrospective cohort of discharged in-patients, who represent a high-need portion of the population. METHODS: We examined routine clinical records of all patients aged 45+ years with chronic conditions discharged from public general hospitals in 2005 in Hong Kong...
December 20, 2018: European Journal of Internal Medicine
Deepa P Rao, Parth Patel, Karen C Roberts, Wendy Thompson
INTRODUCTION: Canadians are living longer than before, and a large proportion of them are living with obesity. The present study sought to describe how older participants in the Canadian Longitudinal Study on Aging (CLSA) who are living with obesity are aging, through an examination of measures of social, functional and mental well-being. METHODS: We used data from the first wave of the CLSA for people aged 55 to 85 years in this study. We used descriptive statistics to describe characteristics of this population and adjusted generalized logistic models to assess measures of social, functional and mental well-being among obese participants (body mass index ≥ 30 kg/m2) relative to non-obese participants...
December 2018: Health Promotion and Chronic Disease Prevention in Canada
Annika Toots, Robert Wiklund, Håkan Littbrand, Ellinor Nordin, Peter Nordström, Lillemor Lundin-Olsson, Yngve Gustafson, Erik Rosendahl
OBJECTIVES: To investigate exercise effects on falls in people with dementia living in nursing homes, and whether effects were dependent on sex, dementia type, or improvement in balance. A further aim was to describe the occurrence of fall-related injuries. DESIGN: A cluster-randomized controlled trial. SETTING AND PARTICIPANTS: The Umeå Dementia and Exercise study was set in 16 nursing homes in Umeå, Sweden and included 141 women and 45 men, a mean age of 85 years, and with a mean Mini-Mental State Examination score of 15...
November 28, 2018: Journal of the American Medical Directors Association
Bruce Kinosian, Darryl Wieland, Xiliang Gu, Eric Stallard, Ciaran S Phibbs, Orna Intrator
BACKGROUND: Use of a claims-based index to identify persons with physical function impairment and at risk for long-term institutionalization would facilitate population health and comparative effectiveness research. The JEN Frailty Index [JFI] is comprised of diagnosis domains representing impairments and multimorbid clusters with high long-term institutionalization [LTI] risk. We test the index's discrimination of activities-of-daily-living [ADL] dependency and 1-year LTI and mortality in a nationally representative sample of over 12,000 Medicare beneficiaries, and compare long-term community survival stratified by ADL and JFI...
November 29, 2018: BMC Health Services Research
Adam Todd, Jesse Jansen, Jim Colvin, Andrew J McLachlan
The area of "deprescribing" has rapidly expanded in recent years as a positive intervention to reduce inappropriate polypharmacy and improve health outcomes for (older) people with multimorbidity. While our understanding of deprescribing as a process has greatly improved and existing approaches all have patient-centered elements, there is still limited literature exploring the importance of the individual patient context in deprescribing decision-making. This is clearly an important consideration to ensure that any deprescribing approach is ethical, respectful, and successful...
November 29, 2018: BMC Geriatrics
Phoebe Ullrich, Christian Werner, Tobias Eckert, Martin Bongartz, Rainer Kiss, Manuel Feißt, Kim Delbaere, Jürgen M Bauer, Klaus Hauer
BACKGROUND: A version of the Life-Space Assessment in persons with cognitive impairment (LSA-CI) has recently been developed. AIMS: To establish a cut-off value for the newly developed Life-Space Assessment in persons with cognitive impairment (LSA-CI). METHODS: In a cross-sectional study including 118 multimorbid, older persons with cognitive impairment, life-space mobility (LSM) was documented by the LSA-CI. The analysis was rationalized by Global Positioning System (GPS)-based measures of spatial distance from home...
November 7, 2018: Aging Clinical and Experimental Research
Amaia Calderón-Larrañaga, Davide L Vetrano, Luigi Ferrucci, Stewart W Mercer, Alessandra Marengoni, Graziano Onder, Maria Eriksdotter, Laura Fratiglioni
This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle...
October 24, 2018: Journal of Internal Medicine
Sonal Singh, Susan Zieman, Alan S Go, Stephen P Fortmann, Nanette K Wenger, Jerome L Fleg, Barbara Radziszewska, Neil J Stone, Sophia Zoungas, Jerry H Gurwitz
OBJECTIVES: To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. METHODS: The National Institute on Aging and the National Heart, Lung and Blood Institute convened A multidisciplinary expert panel from July 31 to August 1, 2017, to review existing evidence, identify knowledge gaps, and consider whether statin safety and efficacy data in persons aged 75 and older without ASCVD are sufficient; whether existing data can inform the feasibility, design, and implementation of future statin trials in older adults; and clinical trial options and designs to address knowledge gaps...
November 2018: Journal of the American Geriatrics Society
Marie Todd
The population is ageing but many older people are living with chronic multimorbidity, which has a significant impact of all aspects of quality of life. Many of the common chronic conditions suffered by older people either precipitate or compound chronic oedema, which means a wide range of skills and in-depth knowledge is required to deliver holistic care that does not interfere with other treatment modalities. This patient group often presents with highly complex coexisting issues that require highly specialist assessment and management in collaboration with other professionals...
October 1, 2018: British Journal of Community Nursing
Kirsten Moore
Our successes in improving life expectancy has led to increased years of life lived with multimorbidity and dementia with increased support needs. Much of the support given to frail older people is provided by family and informal support networks with significant impact on their physical, psychological, and financial well-being. Demographic and societal changes are reducing the capacity of family to offer this care. Formal home-based, center-based, and long-term/residential/nursing home care services are predominately provided by untrained care staff working under supervision from nursing staff...
September 2018: International Psychogeriatrics
Carlotta M Jarach, Matteo Cesari
It is repeatedly advocated in the medical literature the need of reshaping the care process in order to better address the unmet clinical needs of the highly vulnerable and complex ageing population. In the past twenty years, frailty has assumed the role of an arising and independent geriatric condition, different from disability and multimorbidity. Frailty is highly prevalent in older persons. The proper management of frailty relies on the accurate collection and interpretation of a wide spectrum of information about the health status of the individual...
September 13, 2018: Minerva Medica
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