scholarly journals Hip Fracture in the Setting of Limited Life Expectancy: The Importance of Considering Goals of Care and Prognosis

2018 ◽  
Vol 21 (8) ◽  
pp. 1069-1073 ◽  
Author(s):  
C. Bree Johnston ◽  
Amanda Holleran ◽  
Thuan Ong ◽  
Ursula McVeigh ◽  
Elizabeth Ames
Keyword(s):  
Hip Fracture ◽  
Life Expectancy ◽  
Limited Life Expectancy ◽  
Goals Of Care ◽  
Limited Life

scholarly journals Who Orders Screening Mammograms in Older Women with Limited Life Expectancy?

2019 ◽  
Vol 34 (12) ◽  
pp. 2720-2722 ◽  
Author(s):  
Nancy L. Schoenborn ◽  
Jin Huang ◽  
Cynthia M. Boyd ◽  
Sarah Nowak ◽  
Craig E. Pollack
Keyword(s):  
Life Expectancy ◽  
Older Women ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Screening Mammograms

Drugs and prescribing in the older patient

2020 ◽  
pp. 571-578
Author(s):  
Miles Witham ◽  
Jacob George ◽  
Denis O’Mahony
Keyword(s):  
Side Effects ◽  
Life Expectancy ◽  
Drug Metabolism ◽  
Older People ◽  
Drug Interactions ◽  
Central Component ◽  
Pharmacological Agents ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Great Harm

The use of pharmacological agents is often a central component of medical therapy for older people. Medications can relieve symptoms, improve function, and prevent illness, but they also have the capacity to inflict great harm. Older people are at particular risk of such harms as a result of impaired homeostatic reserve, of altered drug metabolism, the presence of multimorbidity and consequent polypharmacy, which increases both exposure to potentially harmful agents and the chance of drug–drug interactions. The therapeutic priorities for older, frail people may differ when compared to younger, robust patients; limited life expectancy means that attempts to prolong life may become relatively less important than the relief of symptoms and avoidance of side effects and medication burden.

scholarly journals Need for Deprescribing in Hospital Elderly Patients Discharged with a Limited Life Expectancy: The REPOSI Study

2019 ◽  
Vol 28 (6) ◽  
pp. 501-508 ◽  
Author(s):  
Luca Pasina ◽  
Barbara Brignolo Ottolini ◽  
Laura Cortesi ◽  
Mauro Tettamanti ◽  
Carlotta Franchi ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Life Expectancy ◽  
Elderly Patients ◽  
End Of Life ◽  
Drug Prescription ◽  
Inappropriate Medication ◽  
Lipid Lowering ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Preventive Medication

Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs.The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.

Immunotherapy in Older Adults: A Checkpoint to Palliation?

2019 ◽  
pp. e110-e120 ◽  
Author(s):  
Rawad Elias ◽  
Oreofe Odejide
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Advanced Disease ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Limited Life Expectancy ◽  
Goals Of Care ◽  
Limited Life ◽  
Checkpoint Inhibitor Therapy

The excitement about immunotherapy is justified. Patients with advanced disease and limited life expectancy before immune checkpoint inhibitors are now having prolonged and sometimes complete responses to treatment; however, most patients do not respond to checkpoint inhibitors. The hope for a meaningful response with only a limited risk of high-grade toxicity generated a prognostic dilemma for patients with advanced cancers and their treating oncologists. Older adults with advanced cancers are at the intersection of multiple biologic and clinical factors that can influence the efficacy of immunotherapy. Treating physicians should take all of these elements into account when considering treatment options for an older adult with advanced disease. Oncologists should have an honest conversation with their patients regarding the uncertainty around the clinical profile of checkpoint inhibitors. Early high-quality goals of care discussions can help manage expectations of older adults with advanced cancer treated with immunotherapy. We review in this paper select clinical characteristics that are important to consider when evaluating an older adult for checkpoint inhibitor therapy. In addition, we discuss strategies to optimize goals of care discussion given the increasing complexity of prognostication in the immunotherapy era.

scholarly journals Health care professionals' attitudes towards deprescribing in older patients with limited life expectancy: A systematic review

2019 ◽  
Vol 85 (5) ◽  
pp. 868-892 ◽  
Author(s):  
Carina Lundby ◽  
Trine Graabæk ◽  
Jesper Ryg ◽  
Jens Søndergaard ◽  
Anton Pottegård ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Life Expectancy ◽  
Health Care Professionals ◽  
Older Patients ◽  
Limited Life Expectancy ◽  
Limited Life

scholarly journals 065STOPPFRAIL (SCREENING TOOL OF OLDER PERSONS PRESCRIPTIONS IN FRAIL ADULTS WITH LIMITED LIFE EXPECTANCY): CONSENSUS VALIDATION

2016 ◽  
Vol 45 (suppl 2) ◽  
pp. ii1.10-ii12 ◽  
Author(s):  
Amanda Lavan ◽  
Paul Gallagher ◽  
Carole Parsons ◽  
Denis O'Mahony
Keyword(s):  
Life Expectancy ◽  
Older Persons ◽  
Screening Tool ◽  
Limited Life Expectancy ◽  
Limited Life

Multiple cutaneous metastases from laryngeal carcinoma

1997 ◽  
Vol 111 (7) ◽  
pp. 654-655 ◽  
Author(s):  
P. Bhandarkar ◽  
K. M. J. Green ◽  
J. P. de Carpentier
Keyword(s):  
Squamous Cell Carcinoma ◽  
Pain Relief ◽  
Life Expectancy ◽  
Cell Carcinoma ◽  
Laryngeal Carcinoma ◽  
Poor Prognosis ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Cutaneous Metastases ◽  
Limited Life Expectancy ◽  
Limited Life

AbstractA case of laryngeal squamous cell carcinoma recurrence presenting as multiple cutaneous metastases is presented. Such metastases are rare and are associated with a poor prognosis. Treatment is usually aimed at providing pain relief in these patients with a limited life expectancy.

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