scholarly journals A Review on Deprescribing in Elderly

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

scholarly journals Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Hawa O. Abu ◽  
Jane S. Saczynski ◽  
Jordy Mehawej ◽  
Mayra Tisminetzky ◽  
Catarina I. Kiefe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Older Patients ◽  
Logistic Models ◽  
Life Questionnaire ◽  
Meaningful Change ◽  
Patient Centered ◽  
Factors Associated ◽  
Fair Poor

Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.

Determining Treatment for Older Patients with High-Risk MDS and AML: which Factors Predict Optimal Quality of Life?

2016 ◽  
Vol 16 ◽  
pp. S129
Author(s):  
Sara Tinsley ◽  
Brent Small ◽  
Susan McMillan ◽  
Rami Komrokji ◽  
Jeffrey Lancet
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Older Patients ◽  
Optimal Quality

Anaemia

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.

scholarly journals The Relationships Between Fall Risk, Depression, Executive Dysfunctions and Daily Life of Older Adults

2020 ◽  
Author(s):  
Batya Engel Yeger ◽  
Yael Zilbershlag
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
High Risk ◽  
Daily Activity ◽  
Fall Risk ◽  
Daily Life ◽  
Daily Activities ◽  
Activity Performance ◽  
Executive Dysfunctions

Abstract Background: Falling is a major problem in older adults that may significantly reduce health and quality of life (QOL). Body dysfunctions that include depression, cognitive decline and executive dysfunctions may elevate fall risk and impair daily activities and QOL. Yet, most studies evaluate these body dysfunctions using laboratory measures in clinical settings. The present study aimed to: (1) compare these body dysfunctions between high/low risk fallers (2) examine the relationship between these body dysfunctions among the high risk fallers (3) explore the specific contribution of fall risk as a mediator between depression, executive dysfunctions and daily life. Methods: Participants were 123 older adults who live in the community. Depression and cognitive status were measured by the GDS-15 and the MoCA. Fall risk was determined by a questionnaire supported by the Time Up and Go test (TUG). Executive functions (EF) were assessed by the BRIEF-A and the aEFPT medication management assessment. Daily activity performance was measured by the Barthel Index of ADL and the Instrumental ADL Scale. QOL was measured by the World Health Organization Quality of Life Brief Questionnaire. Results: High fall risk was prevalent among 32% of the sample. High risk fallers had significantly lower cognitive level, higher depression, lower EF, lower daily activity performance and lower QOL. Among the high risk group, lower EF as measured in BRIEF-A scales correlated with lower performance of daily activities and lower QOL. SEM model revealed that fall risk mediated between depression, executive dysfunctions and daily life. Conclusions: Depression and executive dysfunctions are more prevalent in older adults with high fall risk and are significantly related to their daily activity performance and to their QOL. Community fall-prevention and rehabilitation programs should screen for fall risk and related body dysfunctions as expressed during daily activity performance and understand their impacts on people’s QOL.

scholarly journals Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Daniel B. Rosen ◽  
Cory D. Benjamin ◽  
Joanna C. Yang ◽  
Connor Doyle ◽  
Zhigang Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
High Risk ◽  
Bone Metastases ◽  
Bone Pain ◽  
Patient Centered ◽  
Palliative Radiation ◽  
Effects Of Radiation ◽  
Painful Bone Metastases

Abstract Background In patients with metastatic cancer, the bone is the third-most common site of involvement. Radiation to painful bone metastases results in high rates of pain control and is an integral part of bone metastases management. Up to one-third of inpatient consults are requested for painful bone metastases, and up to 60% of these patients had evidence of these lesions visible on prior imaging. Meanwhile recent advances have reduced potential side effects of radiation. Therefore, there is an opportunity to further improve outcomes for patients using prophylactic palliative radiation to manage asymptomatic bone metastases. Methods/study design In this trial, 74 patients with metastatic solid tumors and high-risk asymptomatic or minimally symptomatic bone metastases will be enrolled and randomized to early palliative radiation or standard of care. This will be the first trial to assess the efficacy of prophylactic palliative radiation in preventing skeletal related events (SREs), the primary endpoint. This endpoint was selected to encompass patient-centered outcomes that impact quality of life including pathologic fracture, spinal cord compression, and intervention with surgery or radiation. Secondary endpoints include hospitalizations, Bone Pain Index, pain-free survival, pain-related quality of life, and side effects of radiation therapy. Discussion In this study, we propose a novel definition of high-risk bone metastases most likely to benefit from preventive radiation and use validated questionnaires to assess pain and impact on quality of life and health resource utilization. Observations from early patient enrollment have demonstrated robustness of the primary endpoint and need for minor modifications to Bone Pain Index and data collection for opioid use and hospitalizations. With increasing indications for radiation in the oligometastatic setting, this trial aims to improve patient-centered outcomes in the polymetastatic setting. Trial registration ISRCTN Number/Clinical trials.gov, ID:NCT03523351. Registered on 14 May 2018.

scholarly journals QUALITY OF LIFE IN OLDER ADULTS RECEIVING IMMUNE CHECKPOINT INHIBITOR THERAPY

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.

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

BMJ Open ◽  
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.

scholarly journals Pre-Frailty and Frailty in Dialysis and Pre-Dialysis Patients: A Systematic Review of Clinical and Biochemical Markers

2021 ◽  
Vol 18 (18) ◽  
pp. 9579
Author(s):  
Ana Pereira ◽  
Luís Midão ◽  
Marta Almada ◽  
Elísio Costa
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Older Adults ◽  
Biochemical Markers ◽  
Web Of Science ◽  
Routine Care ◽  
Geriatric Syndrome ◽  
Dialysis Patients ◽  
Improve Health

Patients under dialysis are known to be more vulnerable to frailty, a dynamic geriatric syndrome defined as a state of vulnerability to stressors, due to numerous metabolic changes. With rise of life expectancy globally, it is important to understand the complexity of the pathophysiology of frailty and identify possible markers that can help with the prognosis and diagnosis of frailty. The aim of this systematic review is to give an overview of the knowledge regarding clinical and biochemical markers associated with pre-frailty and frailty in dialysis and pre-dialysis patients. In November 2020, PubMed, Embase and Web of Science were searched. Studies regarding biomarkers associated with (pre-)frailty in (pre-)dialysis patients were included. This systematic review identified clinical and biochemical markers in pre-frail and frail patients under dialysis or pre-dialysis published in the literature. This study shows that more investigation is necessary to identify markers that can differentiate these processes to be used as a diagnostic and prognostic tool in routine care and management of geriatric needs. Interventions that can improve health outcomes in pre-frail and frail older adults under dialysis or pre-dialysis are essential to improve not only the individual’s quality of life but also to reduce the burden to the health systems.

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