Oropharyngeal Dysphagia in Older Patients

AbstractDysphagia in older adults can have a profound adverse influence nutrition and hydration status, quality of life, morbidity, mortality and healthcare costs in adults. Identification and management of dysphagia in older adults are most effective when implemented by a team, including a nurse, physician, speech-language pathologist, dietitian and occupational therapist. However, each professional’s role may vary according to the standards, responsibilities and resources available in local settings.

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Cardiovascular care of older adults

BMJ ◽

10.1136/bmj.n1593 ◽

2021 ◽

pp. n1593

Author(s):

Deirdre E O’Neill ◽

Daniel E Forman

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Older Patients ◽

Clinical Status ◽

Functional Decline ◽

Traditional Practice ◽

Care Givers ◽

Geriatric Conditions ◽

Personalized Approach

ABSTRACT Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient’s aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient’s function and quality of life at a time in life when these often become foremost therapeutic priorities.

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A Review on Deprescribing in Elderly

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v11i4.4871 ◽

2021 ◽

Vol 11 (4) ◽

pp. 136-137

Author(s):

Christy Babu ◽

Lincy George ◽

K. Krishnakumar

Keyword(s):

Quality Of Life ◽

Older Adults ◽

High Risk ◽

Older Patients ◽

Adverse Drug Events ◽

Patient Centered ◽

Inappropriate Medications ◽

Related Harm ◽

Improve Health

Deprescribing can be defined as the process of stopping a medication or reducing its dose to reduce adverse effects and improve health outcomes. Elderly people with co morbidities usually have a risk of adverse drug events and these events can only be treated by medicines. Despite the benefits offered by these medicines, older patients are at a high risk of harm caused by these medications. The use of multiple medications for treating the comorbidities may also leads to severe health problems. Deprescribing help to reduce the risk related to inappropriate medicines. Deprescribing is usually a patient centered process which helps to withdraw drugs which are harmful to be prescribed to older patients. Several explicit and implicit tools have been developed internationally to identify these inappropriate medications. Deprescribing of inappropriate medicines would help to reduces drug-related harm and improves the quality of life of older adults. Keywords: Deprescribing, polypharmacy, older adults

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Systematic review of patient-engagement interventions: potentials for enhancing person-centred care for older patients with multimorbidity

BMJ Open ◽

10.1136/bmjopen-2020-048558 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048558

Author(s):

Mathilde Bendix Søgaard ◽

Katrine Andresen ◽

Maria Kristiansen

Keyword(s):

Systematic Review ◽

Older Adults ◽

Patient Engagement ◽

Older Patients ◽

Data Extraction ◽

Beneficial Effects ◽

Life Years ◽

Patient Reported ◽

Engagement Interventions

IntroductionPerson-centred care based on systematic and comprehensive patient-engagement is gaining momentum across healthcare systems. Providing care that is responsive to the needs, values and priorities of each patient is important for patients, relatives and providers alike, not least for the growing population of older patients living with multi-morbidity and associated complex care trajectories.ObjectivesThe aim of this systematic review is to investigate the effects of patient engagement interventions for older patients with multimorbidity.MethodsSystematic review conducted in August 2021. Two reviewers independently screened the international databases Embase and PubMed. Reviewers carried out duplicate and independent data extraction and assessment of study quality. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of the evidence for each study.ResultsWe included twelve studies from primary care setting and hospitals. The included studies were heterogeneous in terms of characteristics of populations, types of interventions to enhance patient-engagement, outcome measures and length of follow-up. Nine of the 12 included studies found significant improvements in health and patient-reported outcomes such as higher quality-adjusted life-years, fewer hospital visits and disease specific symptoms. Quality of the included studies was of low to moderate.ConclusionThis review identifies potential beneficial effects of interventions to enhance patient-engagement in older adults with multimorbidity. Nevertheless, the limited and very diverse evidence-based calls for more robust studies into efficient approaches to engaging older adults with multimorbidity in care trajectories.

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Anaemia

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0147 ◽

2017 ◽

pp. 1133-1138

Author(s):

Ammon M. Fager ◽

Harvey Jay Cohen

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Older Patients ◽

Functional Decline ◽

Functional Deficits ◽

Mild Anaemia ◽

Clinical Trial Evidence ◽

The Impact ◽

Trial Evidence

Anaemia is an important problem in the older population. As it is usually mild and insidious in onset, the symptoms of anemia are often overlooked by older adults who attribute their symptoms to an inevitable consequence of ageing while clinicians may ignore mild anaemia in favour of focusing on more prominent comorbidities. However, anaemia in older adults is associated with significant mortality and decreased quality of life due to functional decline. As our understanding of anaemia in elderly people on a biological and clinical level increases, our ability to impact the functional deficits associated with it will improve. However, quality clinical trial evidence on the impact of anaemia and its treatment on crucial outcomes in older patients is currently lacking. The completion of such trials will be critical to assure the safety and efficacy of future interventions designed to improve the treatment and quality of life for older adults.

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QUALITY OF LIFE IN OLDER ADULTS RECEIVING IMMUNE CHECKPOINT INHIBITOR THERAPY

Innovation in Aging ◽

10.1093/geroni/igz038.1145 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S313-S313

Author(s):

Aasha I Hoogland ◽

Sarah L Eisel ◽

Nathaly E Irizarry-Arroyo ◽

Brian James ◽

Jori Mansfield ◽

...

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Older Adults ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Older Patients ◽

Well Being ◽

Over Time

Abstract Immune checkpoint inhibitors (ICIs) have generated significant excitement for their ability to extend survival in patients with lung, head and neck, and other cancers. In older adults with cancer, emerging research suggests that ICIs improve overall and progression-free survival, but few studies have reported on quality of life (QOL). The goal of this study was to examine changes in QOL over time in older (65+ years) vs. younger (<65 years) lung and head and neck cancer patients. Eligible participants scheduled to begin ICI for lung or head and neck cancer completed the Functional Assessment of Cancer Therapy General (FACT-G) every 2-4 weeks until disease progression. Controlling for cancer site, age group differences in QOL over time were evaluated using linear mixed models. A total of 80 lung cancer (mean age=66.5, 55% female, 55% aged 65+) and 55 head and neck cancer patients (mean age=61.5, 15% female, 45% aged 65+) provided consent. At baseline, patients with head and neck cancer reported significantly lower overall QOL, physical well-being, and emotional well-being compared to patients with lung cancer (ps<.0001). Older patients had marginally higher baseline emotional well-being than younger patients (p=.07). Across groups, there were increases in social well-being (p=.04) and a trend toward decreasing physical well-being (p=.10) over time. Patients with head and neck cancer reported lower emotional well-being over time than patients with lung cancer (p<.01). There were no age differences in QOL over time. Larger longitudinal studies are needed to better understand QOL in older patients receiving ICIs.

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Individualised physical activity programme in patients over 65 years with haematological malignancies (OCAPI): protocol for a single-arm feasibility trial

BMJ Open ◽

10.1136/bmjopen-2020-046409 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046409

Author(s):

Baptiste Fournier ◽

Emmanuelle Nicolas-Virelizier ◽

Chiara Russo ◽

Olivia Pérol ◽

Guillaume Y Millet ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Older Adults ◽

Physical Function ◽

Older Patients ◽

Feasibility Trial ◽

Haematological Malignancies ◽

Physical Activity Programme ◽

Supervised Exercise

IntroductionOlder adults with cancer suffer from the combined effects of ageing, cancer disease and treatment side effects. The main treatment for patients with haematological malignancies is chemotherapy, associated with significant toxicities. Chemotherapy can alter patients’ physical function and quality of life which are often already diminished in older patients due to ageing and comorbidities. It therefore seems essential to develop and to evaluate interventions capable of preventing physical and psychosocial decline and its consequences. Promoting physical activity is a promising approach to improve physical function and quality of life in older adults with cancer, but there are limited data on the feasibility of such interventions among older patients with haematological malignancies, concomitant to chemotherapy.Methods and analysisOCAPI (OnCogeriatric and Individualized Physical Activity) is a single-arm, interdisciplinary, prospective, interventional, feasibility study. It is intended to include 40 patients (20 patients with acute myeloid leukaemia and 20 patients with non-Hodgkin’s lymphoma) over 65 years in an individualised 6-month physical activity programme. The programme consists of individually supervised exercise sessions with an increasing volume of physical activity either at home and/or in a laminar airflow room (depending on the disease and treatment regimen) followed by unsupervised sessions and phone follow-ups. Patients will receive an activity tracker during the 6 months of the programme. Evaluations will take place at inclusion and at 3, 6 and 12 months to assess the feasibility of the programme and to explore potential changes in physical, psychosocial and clinical outcomes. The results will generate preliminary data to implement a larger randomised controlled trial.Ethics and disseminationThe study protocol was approved by the French ethics committee (Comité de protection des personnes Est I, N°ID-RCB 2019-A01231-56, 12 July 2019). All participants will have to sign and date an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences.Trial registration numberNCT04052126.

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Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

BMJ Open ◽

10.1136/bmjopen-2019-031427 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031427

Author(s):

Rajesh Raj ◽

Srivathsan Thiruvengadam ◽

Kiran Deep Kaur Ahuja ◽

Mai Frandsen ◽

Matthew Jose

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Decision Making ◽

Lived Experiences ◽

Older Patients ◽

Information Needs ◽

Treatment Options ◽

Prognostic Scores ◽

Modifiable Factors

ObjectivesThis review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.DesignWe followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.Data sourcesPubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).Eligibility criteria for inclusionArticles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.Data extraction and synthesisTwo independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.Results248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.ConclusionWhen discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.

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Associations of quality of social support and beliefs in curability among older adults with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12049 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12049-12049

Author(s):

Lee Kehoe ◽

Michael Sohn ◽

Lu Wang ◽

Supriya Gupta Mohile ◽

Amita Patil ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Advanced Cancer ◽

Geriatric Assessment ◽

Older Patients ◽

Secondary Analysis ◽

Cancer Type ◽

Incurable Cancer ◽

Disease Understanding

12049 Background: Prior studies suggest that social support plays a role in disease understanding of older patients with advanced cancer. In this study, we examined the association of quantity and quality of social support with belief in curability among older patients with advanced incurable cancer. Methods: We performed a secondary analysis of a cluster-randomized geriatric assessment trial (URCC 13070: PI Mohile) that recruited older adults (≥70) with advanced incurable cancer and caregivers. At enrollment, patients completed the Older Americans Resources and Services (OARS) Medical Social Support form to measure both quantity (number of close friends and relatives) and quality of social support. Quality of social support was measured using twelve questions, each ranged from 1 (none of the time) to 5 (all of the time). Higher cumulative scores indicated greater quality of support. For beliefs in curability, patients were asked, “What do you believe are the chances that your cancer will go away and never come back with treatment?” Responses were 0%, <50%, 50/50, >50%, and 100%. Ordinal logistic regression was used to investigate the association of social support with beliefs in curability, adjusting for adjusting for age, gender, education, race, number of Geriatric Assessment (GA) impairments, cancer type, and locality (rural versus urban). Results: We included 347 patients; mean age was 76.4 years, 91% were white, 52% were male, 46% had household income <$50,000, and 55% had high school degree or higher. For every unit increase in OARS Medical Social Support score, the odds of believing in curability decreases by 36.4% [Adjusted Odds Ratio (AOR) 0.733, 95% Confidence Interval (CI): (0.555, 0.969)], after controlling for covariates. Quantity of social support was not associated with belief in curability [AOR 1.033 95% CI: (0.921, 1.156)]. Conclusions: Our study revealed that older patients with advanced cancer who felt more supported by their social network were more likely to report that their cancer was not curable. Interventions that improve quality of social support may also affect disease understanding. Funding: Patient-Centered Outcomes Research Institute (PCORI) 4634 and NIH K24 AG056589 to SGM, NCI UG1CA189961, T32CA102618, NCI K99CA237744 to Loh.

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Pharmacovigilance in Older Adults

10.5772/intechopen.98665 ◽

2021 ◽

Author(s):

Daniel Gomes ◽

Eva Rebelo Gomes ◽

Inês Ribeiro-Vaz ◽

Maria Teresa Herdeiro ◽

Fátima Roque

Keyword(s):

Older Adults ◽

Healthcare Costs ◽

Older Patients ◽

Aging Process ◽

Hospital Admissions ◽

Inappropriate Medication ◽

Drug Effects ◽

The Elderly ◽

Adverse Drug Effects ◽

Age Range

Polypharmacy and physiological changes inherent to the aging process can cause significant modifications in the pharmacokinetic and dynamic regimens of drugs, making the elderly more susceptible to adverse drug effects. Adverse drug reactions (ADR) in older adults have a significant impact on hospital admissions, increasing hospital stay and healthcare costs. Most common ADR in this population are dose-related and predictable. However, they can be difficult to diagnose as they often have nonspecific symptoms. This could be minimized by decreasing the use and prescription of potentially inappropriate medication and being aware of possible drug interactions. Besides, being older patients underrepresented in clinical trials and due to their physiological modifications, serious or atypical ADR are more common in this age range. To minimize harm in older adults, effective pharmacovigilance must be encouraged.

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Pain in Older Patients

Pain Care Essentials ◽

10.1093/med/9780199768912.003.0020 ◽

2019 ◽

pp. 319-338

Author(s):

Staja Q. Booker ◽

Keela A. Herr

Keyword(s):

Older Adults ◽

Pain Management ◽

Older Patients ◽

Best Practice ◽

Management Plan ◽

High Risk Population ◽

Patient Centered ◽

Assessment And Treatment ◽

Centered Care

Chapter 19 discusses the complexities of pain assessment and treatment in older adults and provides best practice recommendations for comprehensive pain management. Pain in older patients is a common, yet significant quality-of-life issue necessitating accurate assessment and safe multimodal treatment. The assessment and treatment of older adults in pain pose distinct challenges and unique opportunities to provide proactive and patient-centered care for a high-risk population with complex health needs. Thus, it is important that providers are prepared to identify these challenges and implement an effective and safe pain management plan.

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