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The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on elderly or other clinical topics then use Trip today.
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Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years. Randomized trials have shown that initiating breast cancer screening between ages 50 and 69 years and continuing it for 10 years decreases breast cancer mortality. However, no trials have studied whether or when women can safely stop screening mammography. An estimated 52% of women aged 75 years or older undergo screening mammography in the United States.To estimate the effect of breast cancer (...) screening on breast cancer mortality in Medicare beneficiaries aged 70 to 84 years.Large-scale, population-based, observational study of 2 screening strategies: continuing annual mammography, and stopping screening.U.S. Medicare program, 2000 to 2008.1 058 013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography.Eight-year breast cancer mortality, incidence, and treatments, plus the positive
Mortality and Hospitalizations for Dually Enrolled and Nondually Enrolled Medicare Beneficiaries Aged 65 Years or Older, 2004 to 2017. Medicare beneficiaries who are also enrolled in Medicaid (dually enrolled beneficiaries) have drawn the attention of policy makers because they comprise the poorest subset of the Medicare population; however, it is unclear how their outcomes have changed over time compared with those only enrolled in Medicare (nondually enrolled beneficiaries).To evaluate annual (...) changes in all-cause mortality, hospitalization rates, and hospitalization-related mortality among dually enrolled beneficiaries and nondually enrolled beneficiaries.Serial cross-sectional study of Medicare fee-for-service beneficiaries aged 65 years or older between January 2004 and December 2017. The final date of follow-up was September 30, 2018.Dual vs nondual enrollment status.Annual all-cause mortality rates; all-cause hospitalization rates; and in-hospital, 30-day, 1-year hospitalization
& Development Management eBrief no. 170 » Issue 170 March 2020 The report is a product of the VA/HSR&D Evidence Synthesis Program. Deprescribing for Older Veterans: A Systematic Review More than 40% of people in the United States age ≥65 years take five or more prescription medications on a regular basis to control or prevent disease symptoms and complications. The number of medications a person is taking may be the single most important predictor of adverse drug effects. Efforts have been underway for more (...) medications, and medications known to pose risks in the elderly. The VA Center for Medication Safety in Aging was charged with the development and implementation of deprescribing approaches in VA settings. Commissioned by the National Center for Patient Safety and endorsed by VA Pharmacy Benefits Management and the Geriatrics and Extended Care Services, the purpose of this evidence review is to inform that work. Specific questions to be addressed included: What are the effectiveness, comparative
" OR AB "Health promotion") 1236 4. 1 OR 2 OR 3 5690 Population: 5. DE "OLDERpeople" 7927 6. (TI (elderly OR aged OR old*) N2 (person* OR people* OR m#n OR wom#n OR patient*)) OR (AB (elderly OR aged OR old*) N2 (person* OR people* OR m#n OR wom#n OR patient*)) 29086 7. (TI (geriatric* OR "senior citizen*")) OR (AB (geriatric* OR "senior citizen*")) 4799 8. 5 OR 6 OR 7 36564 Study types: 9. DE "Systematic reviews (Medical research)" OR DE "Cochrane reviews" OR DE "Meta-analysis" 5181 10. (TI (...) Population: 5. exp Aged/ 3041480 6. ((elderly or aged or old$) adj2 (person$ or people$ or m?n or wom?n or patient$)).ti,ab. 714320 7. (geriatric$ or senior citizen$).ti,ab 46885 8. 5 OR 6 OR 7 3469976 Study types: 9. Exp systematic review/ OR cochrane library.mp OR exp meta analysis/ 191889 10. ((systematic* ADJ3 review) OR meta analy* OR metaanaly*).ab,ti,kw 255856 11. 9 OR 10 282791 Combined sets: 12. 4 AND 8 5311 Final 11 AND 12 102 Cochrane Library via Wiley 2020-01-14 Preventive home visits
with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were (...) included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly
Happiness or hopelessness in late life: A cluster RCT of the 3L-Mind-Training programme among the institutionalized olderpeople To explore the effectiveness of a new mental health promotion activities programme by including the criterion variables of happiness and depressive mood.A single-blinded, clustered, randomized and controlled trial.A list consisting of the names of elderly residents was provided by the senior social worker at a geriatric institution. The participants recruited (...) to measure happiness. The Geriatric Depression Scale short-form was used to measure depression in olderpeople. A generalized estimating equation was used to analyse the short-term and durative effects.The 126 residents included in the study were 65-97 years old, and 90% of the residents relied on wheelchairs. The intervention activities give significant immediate and durative effects both on subjective well-being enhancement and depressive mood relief. When evaluating the overall intervention activity
Acupuncture vs Noninsertive Sham Acupuncture in Aging Patients with Degenerative Lumbar Spinal Stenosis: A Randomized Controlled Trial Acupuncture is commonly used to treat degenerative lumbar spinal stenosis in Asian countries. However, rigorous data regarding the efficacy and safety of acupuncture for aging patients are currently lacking.Eighty patients older than 50 years were assigned randomly to the acupuncture group or the noninsertive sham acupuncture for 24 treatments over an 8-week
Epilepsy in olderpeople. Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in olderpeople, explore difficulties in establishing a diagnosis of epilepsy in this population (...) , discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of olderpeople with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular
Screening for Cognitive Impairment in Older Adults: US Preventive Services Task Force Recommendation Statement. Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age.To update its 2014 recommendation, the US Preventive Services Task Force (...) (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities.This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment.The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening
mortality at 90 days in ICU patients aged 65 years or older with vasodilatory hypotension.A multicenter, pragmatic, randomized clinical trial was conducted in 65 ICUs in the United Kingdom and included 2600 randomized patients aged 65 years or older with vasodilatory hypotension (assessed by treating clinician). The study was conducted from July 2017 to March 2019, and follow-up was completed in August 2019.Patients were randomized 1:1 to vasopressors guided either by MAP target (60-65 mm Hg, permissive (...) Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial. Vasopressors are commonly administered to intensive care unit (ICU) patients to raise blood pressure. Balancing risks and benefits of vasopressors is a challenge, particularly in older patients.To determine whether reducing exposure to vasopressors through permissive hypotension (mean arterial pressure [MAP] target, 60-65 mm Hg) reduces
and implementing services to support olderpeople's healthy ageing. Published 28 January 2020 From: Documents Ref: PHE publications gateway reference GW-1008 If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email . Please tell us what format you need. It will help us if you say what assistive technology you use. Ref: PHE publications gateway reference GW-1008 If you use assistive technology (such as a screen reader) and need (...) on identified interventions to support olderpeople, generated through a literature review. The return on investment (ROI) tool: can be adapted to local conditions presents results showing the economic benefits of each intervention has a built-in user guide Local authorities and clinical commissioning groups can use these resources to improve the provision of services for olderpeople. Published 28 January 2020 Related content Explore the topic Is this page useful? Thank you for your feedback Help us
Plerixafor (Mozobil) - children aged 1 year to <18 years with lymphoma or solid malignant tumours Published 10 February 2020 1 Product update SMC2249 plerixafor 20mg/mL solution for injection (Mozobil®) Sanofi Aventis 10 January 2020 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following an abbreviated (...) submission plerixafor (Mozobil®) is accepted for use within NHSScotland. Indication under review: in combination with granulocyte-colony stimulating factor (G-CSF) to enhance mobilisation of haematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in children aged 1 year to <18 years with lymphoma or solid malignant tumours, either: - pre-emptively, when circulating stem cell count on the predicted day of collection after adequate mobilisation with G-CSF
, Nankin HR , Spark RF , et al American Association of Clinical Endocrinologists American Association of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients—2002 update. Endocr Pract 2002 Nov-Dec 8 440 56 Wu FC , Tajar A , Beynon JM , et al EMAS Group Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010 363 123 35 Bassil N , Morley JE . Late-life onset hypogonadism: a review (...) . Clin Geriatr Med 2010 26 197 222 Nguyen CP , Hirsch MS , Moeny D , et al Testosterone and “Age-related hypogonadism”—FDA concerns. N Engl J Med 2015 373 689 91 Diem SJ , Greer NL , MacDonald R , et al Efficacy and safety of testosterone treatment in men: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 7 January 2020 [Epub ahead of print] Qaseem A , Kansagara D , Lin JS , et al Clinical Guidelines Committee of the American College
Validation of the Elderly Risk Assessment Index in the Emergency Department The Elderly Risk Assessment (ERA) score is a validated index for primary care patients that predict hospitalizations, mortality, and Emergency Department (ED) visits. The score incorporates age, prior hospital days, marital status, and comorbidities. Our aim was to validate the ERA score in ED patients.Observational cohort study of patients age ≥ 60 presenting to an academic ED over a 1-year period. Regression analyses (...) were performed for associations with outcomes (hospitalization, return visits and death). Medians, interquartile range (IQR), odds ratios (OR) and 95% confidence intervals (CI) were calculated.The cohort included 27,397 visits among 18,607 patients. Median age 74 years (66-82), 48% were female and 59% were married. Patients from 54% of visits were admitted to the hospital, 16% returned to the ED within 30 days, and 18% died within one year. Higher ERA scores were associated with: hospital admission