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Latest & greatest articles for elderly
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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recommendations therefore cannot be provided as the inclusion and exclusion criteria from available systematic reviews and research literature are often too restrictive and unhelpful. Often, the clinical recommendations are single-disease specific, and fail to consider comorbidities, patient needs and polypharmacy that most (if not all) olderpeople experience. Some clinical practice points and general principles are provided in each chapter. A ‘Consensus-based recommendation’ denotes a practice point (...) Common clinical conditions in aged care (Silver Book) RACGP - Silver Book - Part A Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship Fellowship International
clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily (...) Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community.To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community.Parallel, 2-group randomized clinical trial conducted at 3 US
of receipt of Medicare Part D low-income subsidies and not capturing persons not enrolled in Medicare Part D.Low-income, older adults living in more affluent areas of the country are healthier, and areas with poor health in the low-income, older adult population tend to have a high prevalence of most chronic conditions.National Institute on Aging. (...) Local Area Variation in Morbidity Among Low-Income, Older Adults in the United States: A Cross-sectional Study. Recent studies have reported that low-income adults living in more affluent areas of the United States have longer life expectancies. Less is known about the relationship between the affluence of a geographic area and morbidity of the low-income population.To evaluate the association between the prevalence of chronic conditions among low-income, older adults and the economic affluence
Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our (...) analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were
.A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate-lowering drugs (RLDs) and/or anti-arrhythmic drugs (AADs) were included. We compared the use of rate-lowering monotherapy with rate-lowering dual therapy, AAD monotherapy, and AAD combined with rate-lowering therapy.Outcomes were fall-related injuries and syncope as a composite end point (primary) or separate end point (secondary).In this population, the median age was 78 years (interquartile range [IQR] = 72-84 y (...) with rate-lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall-related injuries and syncope (IRR = 1.40 [1.26-1.55]). Compared with more than 180 days of rate-lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs.In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall-related injuries
on a complete discontinuation of treatment. 1 Product availability date April 2019. Summary of evidence on comparative efficacy The activity of melatonin at the melatonin receptors (MT1, MT2 and MT3) is believed to contribute to its sleep-promoting properties, as these receptors (mainly MT1 and MT2) are involved in the regulation of circadian rhythms and sleep regulation. 1 A double-blind phase III study recruited children and young peopleaged 2 to 17.5 years with an autism spectrum disorder diagnosed (...) Melatonin (Slenyto) - Treatment of insomnia in children and adolescents aged 2 to 18 years with autism spectrum disorder and / or Smith-Magenis syndrome 1 Published 9 September 2019 1 SMC2168 melatonin 1mg and 5mg prolonged-release tablets (Slenyto®) Flynn Pharma Ltd 9 August 2019 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
Efficacy and safety of linagliptin to improve glucose control in olderpeople with type 2 diabetes on stable insulin therapy: A randomized trial To assess the addition of linagliptin as an alternative to insulin uptitration in olderpeople with type 2 diabetes on stable insulin therapy.This phase 4, randomized, multicentre, double-blinded, placebo-controlled, 24-week study recruited individuals on stable insulin, with baseline HbA1c 7.0%-10.0%, aged ≥60 years and body mass index ≤45 kg/m2 (...) . HbA1c and fasting plasma glucose were measured at study visits, and participants assessed glycaemic control with a self-monitoring blood glucose device. Adverse events (AEs) were reported during the study.Three hundred and two participants were randomized 1:1 to linagliptin 5 mg qd and placebo, with one third of patients from Japan. Study population age and HbA1c (baseline mean ± SD) were 72.4 ± 5.4 years and 8.2 ± 0.8%, respectively; ~80% of participants were aged ≥70 years; 80% had macrovascular
Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure -1- Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Modified from CDC a-e , FDA f,g and WHO h Published Guidance) Updated August 2018 Planning Pregnancy for Infected, Exposed, or Possibly Exposed Individuals In September 2016, the ASRM issued a Zika guidance for providers that addressed the care of non-pregnant patients desiring pregnancy (...) ) for the woman and 3 vs. 6 months for men with Zika virus disease should be made using a shared patient-provider decision-making model taking into account any new available data and such variables as age of the female patient and other infertility factors with documentation of the conversation and decision. 4. Symptomatic women and men attempting pregnancy through ART with possible Zika virus exposure should have testing that includes the Zika virus nucleic acid test (NAT) to rule out active Zika infection
Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial. To demonstrate the efficacy of a system for comprehensive care transfer (Multilevel Guided Discharge Plan [MGDP]) for frail older patients diagnosed with acute heart failure (AHF) and to validate the results of MGDP implementation under real clinical conditions. The MGDP seeks to reduce the number of adverse outcomes within 30 days (...) of emergency department (ED) discharge.We will enroll frail patients over the age of 70 years discharged home from the ED with a main diagnosis of AHF. The MGDP includes the following components: 1) a checklist of clinical recommendations and resource activations, 2) scheduling of an early follow-up visit, 3) transfer of information to the primary care doctor, and 4) written instructions for the patient. Phase 1 of the study will be a matched-pair cluster-randomized controlled trial. Ten EDs
of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 (...) Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia.Prospective cohort study.Civil service departments in London (Whitehall II study; study inception 1985-88).7899 participants with data on the cardiovascular health score at age 50.The cardiovascular health score included four behavioural (smoking, diet
Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 - ACOG Menu ▼ Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 Page Navigation ▼ Practice Advisory: FDA Approval of 9-valent HPV Vaccine for Use in Women and Men Age 27-45 On October 5, 2018 the FDA approved the use of the 9-valent HPV vaccine in women and men aged 27 (...) through 45 years (1). The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) reviewed the available data at its February 2019 and June 2019 in-person meetings. On June 26, 2019, ACIP voted to recommend shared clinical decision making for persons aged 27 through 45 years when considering the 9-valent HPV vaccine. This recommendation is for women who have not previously received an HPV vaccine series and who are at risk for acquisition of HPV. HPV
at time intervals recommended by guidelines, such as those noted by the Canadian Task Force on the Periodic Health Examination. Don’t order DEXA (Dual-Energy X-ray Absorptiometry) screening for osteoporosis on low risk patients. While all patients aged 50 years and older should be evaluated for risk factors for osteoporosis using tools such as the osteoporosis self-assessment screening tool (OST), bone mineral density screening via DEXA is not warranted on women under 65 or men under 70 at low risk (...) Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th Don’t do imaging for lower-back pain unless red flags are present. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging
were included. Study contexts were general medical wards (n = 11, 73.3%), Acute care of the elderly unit (n = 3, 20%) and a nursing unit (n = 1, 6.7%) located in tertiary referral acute hospitals. Most participants were aged 75-84 years (n = 10, 66%), had variable medical diagnoses and samples were either physically capable (n = 4, 26.7%) of limited physical capability (n = 1, 6.7%) or of mixed capability to mobilise independently (n = 10, 66.7%). Walking at least twice a day for approximately 20 (...) min in total appeared to be associated with less functional decline in older patients of variable physical capabilities, and the overall efficacy of twice-daily exercise to reduce functional decline was supported.The evidence tentatively supported walking for hospitalised elders, irrespective of physical capability, and based on one RCT, suggested likely benefits of graduated exercise in dependent elders. Insufficient evidence limits prescription of optimal doses of physical activity to minimise
Nonoperative Treatment Compared with Volar Locking Plate Fixation for Dorsally Displaced Distal Radial Fractures in the Elderly: A Randomized Controlled Trial The usage of volar locking plate fixation for distal radial fractures has increased in older patient populations, despite the fact that surgical treatment in the elderly population has not clearly been proven to be superior to nonoperative treatment. The purpose of the present study was to compare nonoperative treatment with volar locking (...) plate fixation with regard to clinical outcome for elderly patients with dorsally displaced distal radial fractures.In this study, 140 patients were randomly allocated to nonoperative treatment with a plaster splint (n = 72) or volar locking plate fixation (n = 68). The outcome variables were the Patient-Rated Wrist Evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, EuroQol-5 Dimensions (EQ-5D) score, range of motion, grip strength, radiographic outcomes
perampanel tablets. Treatment should be initiated only by physicians who have appropriate experience in the treatment of epilepsy. SMC has previously accepted perampanel tablets for restricted use as adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in patients with epilepsy aged 12 years and older. The oral suspension provides an alternative formulation for patients who have difficulty swallowing tablets. Depending on the dose, it may be more expensive than (...) Perampanel (Fycompa) - for the adjunctive treatment of partial-onset seizures with or without secondarily generalised seizures in adult and adolescent patients from 12 years of age with epilepsy. Published 12 August 2019 1 Product update SMC2172 perampanel 0.5mg/mL oral suspension (Fycompa®) Eisai Ltd 5 July 2019 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
Perampanel (Fycompa) - for the adjunctive treatment of primary generalised tonic-clonic seizures in adult and adolescent patients from 12 years of age with idiopathic generalised epilepsy. Published 12 August 2019 www.scottishmedicines.org.uk Statement of advice SMC2218 perampanel 0.5mg/mL oral suspension (Fycompa®) Eisai Ltd 5 July 2019 Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish (...) with the patient and/or guardian or carer. Chairman Scottish Medicines Consortium ADVICE: in the absence of a submission from the holder of the marketing authorisation perampanel (Fycompa®) is not recommended for use within NHSScotland. Indication under review: for the adjunctive treatment of primary generalised tonic-clonic seizures in adult and adolescent patients from 12 years of age with idiopathic generalised epilepsy. The holder of the marketing authorisation has not made a submission to SMC regarding
Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China.Regression discontinuity analysis using data from a national cohort study.2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults (...) in China.3899 older adults who had previously undiagnosed hypertension.Community based hypertension screening among older adults in 2011-12.Blood pressure two years after initial screening.The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non