Frequent drinkers unravelled

Beth Bareham, NIHR SPCR  doctoral fellow at Newcastle University Institute of Health and Society and Institute for Ageing (@bkateb1) She co-authored the Age and Ageing Paper Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences with Professor Eileen Kaner @EileenKaner, Liam Spencer @LiamPSpencer and Professor Barbara Hanratty @BarbaraHanratty.

Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst  older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities. 

Drug burden in older people approaching end of life

Dr. Denis Curtin is a specialist registrar in Geriatric Medicine in Cork University Hospital, Ireland. His paper Drug consumption and futile medication prescribing in the last year of life: an observational study was recently published the Age and Ageing journal.

The vast majority of older adults are admitted to hospital in their last year of life. For many of these people, hospitalizations are frequent and prolonged.

We reviewed the medical records of 410 older adults who were admitted to our hospital in the year prior to death. The median number of days spent in hospital was 32. While in hospital, patients consumed an average of 24 different medications. One-in-six patients consumed 35 or more individual medications. When discharged home from hospital, patients were prescribed an average of 2 unnecessary or inappropriate medications.

‘How low to go?’ Top transatlantic research journals debate antihypertensive treatment in older people

The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.

It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients.

Why it gets harder to prevent falls when older people leave hospital

Chiara Naseri is a physiotherapist and is currently completing her PhD at Western Australia’s Curtin University School of Physiotherapy and Exercise Science. She has recently published a review in Age and Ageing entitled “Reducing falls in older adults recently discharged from hospital: A systematic review and meta-analysis.”

The paper reveals the complexity of the discharge process for older people and that more support is required than is currently widely recognised. Her team found that falls prevention strategies, known to reduce falls for older people in general, were not as effective for older people following hospital discharge.

Evidence has shown 30% of the population of older people who live in the community fall at least once per year, 10% of these falls result in a serious injury. Whereas 40% of the population of older people who have recently been discharged home from hospital fall within 6 months of discharge, most of these falls occur in the first month and 54% result in a serious injury, particularly hip fractures.

The ‘Geriatrician’s Salute’: emerging evidence on deprescribing

Professor Sarah Hilmer works as a geriatrician and clinical pharmacologist at Royal North Shore Hospital in Sydney, and conjoint professor of geriatric pharmacology at Sydney University, Australia.  Dr Danijela Gnjidic is a pharmacologist who is a NHMRC Dementia Leadership Fellow and Senior Lecturer in Pharmacy Practice at Sydney University, Australia. 

One of the most reversible causes of a geriatric syndrome in our older patients is an adverse drug event.  Approximately 1 in 5 hospital admissions amongst older people are due to adverse drug reactions and during their time in hospital 1 in 6 older people experience an adverse drug reaction.  Consequently, comprehensive medication review is an integral part of the practice of geriatric medicine.

The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in their patient has been given a variety of names including the ‘geriatrician’s salute’ and increasingly ‘deprescribing’. 

May 2018 issue of Age and Ageing journal is out now

The May 2018 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.  

Hot topics in this issue include:

• New pain assessment guideline
• Future population burden of
  multimorbidity
• Systemic anti-cancer treatment for
  older people
• Treating malnutrition in care homes
• Effects of different types of
  exercise in older people
• Research methods – diagnostic test
  accuracy studies

The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here.

Other than exercising? Another way for fear of falling…

Mr. Tai-Wa LIU is a Senior Lecturer at the Open University of Hong Kong.  In this blog, he shares a recent Age and Ageing publication looking at the effectiveness of cognitive behavioral therapy in reducing fear of falling and improving balance among older people.

Whenever you are afraid of losing balance in doing something, it means you might have fear of falling.  For example, a baby first tries to stand on its own, or a kid learns cycling.  We all have had this fear of falling, especially in situations where we might get hurt or be embarrassed in public. This fear is normal and self-protective in nature, but the reality is that older people with excessive levels of this fear could lead to restricted activity of daily living, limited social participation and physical deconditioning.  Eventually, it could lead to increased fall risks and form the vicious cycle of “fear of falling and actual falls”.

For some reasons, such as deteriorated physical ability or previous fall experiences, fear of falling is common among older people.  The origin of this excessive level of fear is believed to be psychological and stems from the impaired balance confidence and over-pessimistic view regarding the consequences of falls. 

“Doc, I read on the Internet that probiotics might help me. Is it true?”

Patrick Alexander Wachholz  is a Geriatrician, Research associate at Botucatu Medical School, São Paulo State University (UNESP). His paper Effectiveness of probiotics on the occurrence of infections in older people: systematic review and meta-analysis was recently published in Age and Ageing journal.

In 2001, an international Joint Expert Consultation of sci­entists working on behalf of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.

Probiotics are intended to have health benefits, and in some countries we can find a huge variety of products sold as probiotics including foods (such as yogurt and fermented milk), dietary supplements, and products that aren’t used orally, such as skin or vaginal creams.

15 years of dementia treatment in 15 papers: an online themed collection in A&A

Elizabeta Mukaetova-Ladinska is Professor of Old Age Psychiatry at Leicester University and an Associate Editor at Age and Ageing journal. She has curated this free collection of papers on the theme of treatments in dementia.

Age and Ageing journal is delighted to be able to publish this free online collection of 15 papers to provide an update on the advances of pharmacological and non-pharmacological interventions in dementia over the last 15 years. The published studies reflect the efficacy of the current anti-dementia treatments, preventive treatments of cardio and cerebrovascular incidents (known to be risk factors for dementia), alongside the use of antidepressant medication and non-pharmacological interventions for treatment of behavioural and psychopathological symptoms of dementia (BPSD). We also address the future preventative steps and therapeutic strategies currently in development to combat the devastating consequences of dementia.

New guidelines for recognising and assessing pain in older adults

New recommendations to help healthcare professionals recognise and assess levels of pain in older people were published today in the scientific journal Age and Ageing. The guidelines were developed by the British Geriatrics Society, the British Pain Society, the Royal College of Nursing, in collaboration with researchers at Teesside University, Anglia Ruskin University, University of Bournemouth, Centre for Ageing Better, and the Centre for Positive Ageing.

There is growing evidence to demonstrate that chronic pain is more prevalent among the older population and pain that interferes with everyday activities increases with age. Alleviating pain in the older population is therefore a priority but presents a number of challenges, especially in relation to communication with patients. These guidelines seek to address specific areas in which improvements can be made. To support this aim all existing publications on acute and chronic pain screening and assessment in adults over 60 years of age were identified, and two reviewers independently read and graded the papers according to the National Health and Medical Research Council criteria (1999b).