Shane O’Hanlon’s Age & Ageing Christmas Review- Part 1

Shane O’Hanlon is the Digital Media Editor for the BGS. He tweets @drohanlon

shaneAge and Ageing begins 2017 with a swish new look, but first let’s look back at the most downloaded journal articles of 2016…

  1. Helen Jones and colleagues looked at the theory that selective serotonin reuptake inhibitors (SSRIs) may affect the neurodegenerative process of dementia, enhancing cognition. To investigate this, they performed a systematic review of placebo-controlled RCTs. A small number of relatively low-powered studies showed no benefit or harm from SSRIs in terms of cognition, mood, agitation or ADLs in dementia. There was insufficient data to say whether SSRIs are beneficial for cognition, and there was some suggestion of increased side effects.

  1. Staying with mental health, Kate O’Hara and her group performed a cross-sectional survey across nine prisons in the North of England. The aim was to examine unmet health and social care needs among older men entering prison and their links with depressive symptoms. There were high levels of unmet needs, most notably in the domains of knowledge about their condition and treatment (38%) and psychological distress (34%). The median number of unmet needs was 2. The authors suggested introducing personalised health and social care needs assessment and discrete depression screening on prison entry.
  1. Shane Cullinane with Denis O’Mahony’s START-STOPP group constructed a frailty index to determine whether a positive relationship exists between a patient’s frailty status, the appropriateness of their medications and their propensity to develop adverse drug reactions (ADRs). Applying the index to a database, they found that patients above a threshold frailty index score of 0.16 were twice as likely to experience potentially inappropriate prescribing and twice as likely to develop an ADR. They concluded that an FI score is a potentially relevant clinical indicator for doctors to critically assess a patient’s prescription for the presence of PIP and ultimately prevent ADRs.
  1. It was over to New York next, and Spruha Joshi’s longitudinal study of older adults’ physical activity. Noting that physical activity may be beneficial in reducing depression incidence among the elderly, they wondered whether certain types of physical activity are particularly associated with decreased depression incidence. They followed 3,497 adults aged 65–75 living in NYC for three years, measuring using the Physical Activity Scale for the Elderly (PASE). Happily, they found that respondents who practised the highest levels of physical activity and who performed athletic activities were at lower risk for depression.
  1. Hospital acquired pneumonia (HAP) is a serious condition, but few data exist on incidence or risk factors, noted Louise Burton and colleagues. They performed a prospective survey over 12 months in one centre and found HAP was suspected in 10% of admissions but diagnostic criteria were only met in around half (mainly because due to lack of radiographic evidence). They reported that HAP was common but over-diagnosed.
  1. Sarah Pendlebury and her team aimed to determine the reliability of externally derived delirium risk stratification scores in a consecutive cohort of older acute medicine patients. Among 308 consecutive patients aged ≥65, existing delirium risk scores had areas under the curve for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior.
  1. Novel oral anticoagulants (NOACs) are now commonly used in place of warfarin, but how about aspirin? Kuan H. Ng and colleagues performed a subgroup analysis of the AVERROES trial to examine the effects of apixaban versus aspirin in older patients compared with younger patients with AF unsuitable for vitamin K antagonists. They found that compared with aspirin, apixaban was more efficacious for preventing strokes and systemic embolism in patients ≥85 years compared with younger patients. Major haemorrhage was higher in patients ≥85 years compared with younger patients but similar with apixaban versus aspirin in both young and older individuals.

Look out for Part 2 where the top 6 downloaded journal articles of 2016 will be revealed!

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