July 2017 issue of Age and Ageing journal is out now

The July 2017 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.AA_46-03

Hot topics in this issue include:

  • Care home leadership
  • Physical restraint
  • Diet and muscle function
  • Prescribing for frail older
    adults
  • Treatment of overactive
    bladder

    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. Continue reading

    July issue of Age and Ageing journal out now

    The July 2016 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 this issue include:

    • Frailty index based on basic laboratory and clinical measures
    • Dietary protein and ageing
    • Do you want to live to be 100
    • Social engagement and cognitive ageing
    • Selective serotonin reuptake inhibitors and progression of dementia

    The Editor’s View can be read here.

    This issue’s free access papers are:

    Better medicine reviews in care homes – a no brainer?

    fotolia-8532456-m(7)Wasim Baqir is a Research & Development Pharmacist at Northumbria Healthcare NHS Foundation Trust.

    There are currently 405,000 care home residents in the UK aged over 65 taking an average of seven medicines, with some taking double or treble this amount. Research shows at any one time 70% of them have an error with their medication which can occur during prescribing, dispensing or administration. That’s a lot of errors.

    I’m a clinical pharmacist working in Northumbria and although these figures are quite well known, they are still pretty shocking.

    Medicines use in care homes is problematic: over-prescribing, lack of structured review and little or no resident involvement in decisions are common themes. Despite the evidence (think CHUMS report) and guidance (think NICE guidelines) medicines use in care homes remains generally poor. That’s why I’m backing a new campaign from the Royal Pharmaceutical Society to improve the situation.

    Continue reading

    Diabetes care in the very old. Beyond the limits of evidence?

    aaDr. Shota Hamada is a Visiting Research Fellow in the Department of Primary Care and Public Health Sciences, King’s College London.

    Very old people have rarely been included in clinical trials in sufficient numbers and treatment recommendations for them are largely based on professional opinion informed by evidence generated from younger patients. Selecting drug treatment for very old people may be influenced by distinct concerns including co-morbidities, declining physical and cognitive functioning, and perceptions of limited life expectancy, that may be less relevant in younger people.

    Our recent research, published in Age and Ageing, investigates changing prescriptions for antidiabetic and cardiovascular medications for very old patients who were newly diagnosed with type 2 diabetes over a 20 year period.

    The study included a representative sample of nearly 13,000 patients from primary care in the UK. From 1990 to 2013, use of sulphonylureas declined rapidly from 94% of patients to 29%, while metformin became the mainstay among antidiabetic drugs, increasing from 22% to 86%. Prescribing of antihypertensive (46% to 77%), lipid-lowering (1% to 64%), and antiplatelet drugs (34% to 47%) also increased substantially in this period.

    These changes in prescribing seem to be motivated by evidence generated from clinical trials in younger people. From the 1990s onward, the results of several large clinical trials have been available, such as UKPDS, ACCORD and 4S, which promoted implementation of intensive multifactorial interventions for patients with diabetes to reduce mortality, cardiovascular diseases and other complications.

    Do these major increases in the intensity of pharmacological management really improve survival or well-being in very old people? We do not have a clear answer to this question. Our present study is surely an initial step to evaluate drug therapy in very old people with diabetes. One of the challenges in making treatment decisions may be so-called “lag time to benefit” or “payoff time”.

    For example, initiation or continuation of antidiabetic drugs should be determined carefully given that it requires several years to obtain benefits from antidiabetic drugs. Further research is needed to justify or adjust prescribing practices in terms of both effectiveness and safety outcomes. We should now prepare to develop evidence-informed strategies for diabetes management in very old people.

     

    March issue of Age & Ageing journal out now

    The March 2015 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 this issue include:

    • New horizons in testosterone
    • Preventing delirium
    • Admissions for osteoporotic pelvic fractures and predictors of mortality
    • Cognitive motor interference

    The Editor’s View can be read here.

    This issue’s free access papers are:

    Inappropriate drug use among older persons: is it time for action?

    Andreas Schoenenberger works with the Division of Geriatrics, Department of General Internal Medicine at Bern University Hospital, and with the University of Bern, Switzerland. Here he describes his recent editorial in Age and Ageing journal, written with Andreas Stuck.Inappropriate Drug

    Despite recent efforts to improve drug management for older people, we have not yet arrived at an optimal strategy for reducing inappropriate drug use. Drugs are considered inappropriate, if the risk outweighs the potential benefit of the drug. Along with pathophysiological changes during the ageing process, and the increasing number of co-morbidities/-medications, the potential risks of drugs increase with age and adverse drug reactions (ADRs) are encountered more frequently in older persons. Continue reading

    Do pharmacists have a role in reducing emergency admissions?

    Alyson Huntley is a Research Fellow at the University of Bristol’s Centre of Academic Primary Care. She has recently published a systematic review of pharmacist-led interventions to reduce unplanned admissions for older people.EmergencyAvoidance

    The expansion of the pharmacist’s role as a contributor to patient’s health has been championed over the last couple of decades.  In addition to their traditional role, pharmacists contribute to the care of people with long term conditions by carrying out medication reviews, promoting healthy lifestyles, and supporting self-care.

    The older people become, the more medications they are likely to be taking (both prescribed drugs and self-medication) leading to an increased risk of adverse reactions, interaction between drugs and poor adherence. Continue reading

    Medicines management of polypharmacy – Making it Safe and Sound

    Stephen Jackson is Professor of Clinical Gerontology at King’s Health Partnerspolypharmacy

    This is a recent King’s Fund Report which takes another look at polypharmacy. It is unclear why as there has been a rather better report published by NHS Scotland. One would assume the King’s fund would check who is doing what before commissioning such a report. Interestingly there is no mention of the G (geriatrician) word anywhere in the report although the terms “older care clinician”, “clinicians who specialise in care of older people” and orthogeriatrician do appear. I thought there was insufficient recognition of the fact that multiple pathology and hence polypharmacy is essentially a problem associated with ageing.  The authors rightly differentiate between appropriate polypharmacy and what they call problematic polypharmacy known to many as inappropriate polypharmacy. Polypharmacy merely means “many medicines” as opposed to “too many medicines”.  The report could be criticised for giving the impression that appropriate prescribing is only necessary when polypharmacy is present. Continue reading

    Which drugs to stop in which older patients?

    Tischa van der Cammen is a Consultant Geriatrician and Carolyn Sterkeis a public health researcher. Both are based at the Erasmus University Medical Center in Rotterdam, Netherlands and have recently published a paper in Age and Ageing journal.polypharmacy

    Drug treatment has brought many benefits for older patients. For example, the treatment of hypertension in patients aged over 80 led to a major reduction in stroke and mortality, as was shown in the HYVET study.

    As people age, diseases may accumulate, and hence older patients usually are prescribed several drugs at the same time. It is ‘rule rather than exception’ that patients above age 75 use 4 or more drugs, this is called polypharmacy. There are a variety of definitions for polypharmacy – in the UK it is generally 4 or more prescribed medicines – as specified by Department of health and Rollason.

    Inappropriate poly-pharmacy in older patients may lead to negative health impacts Continue reading

    The government and the “societal benefits” of care

    Zoe Wyrko is a Consultant Geriatrician at Queen Elizabeth Hospital Birmingham and is the workforce planning lead for the BGS. She tweets at @geri_babyshutterstock_147407087

    I like to think that as a jobbing geriatrician I have a fairly pragmatic attitude towards guidelines. I know that they exist, but I also know that they are not always directly applicable to a frail older person with multiple morbidities, so I’ll look at what they say with a hint of scepticism, and use them when they help me to provide the best care. Extrapolating from this, I tend to see NICE as an organisation that is more for other people than me. I know that the work they do is vital in standardizing care, bringing together groups of experts to decide on treatment pathways and helping to make decisions on which drugs to give when. I have even attended a stakeholder group for the preliminary stages of the guidance they are planning to issue for social care.

    This week however, a statement made by Sir Andrew Dillon, head of NICE, has made me sit up and pay attention. It seems we should be afraid… very afraid. Continue reading