scholarly journals Appropriateness of pharmacological treatment in older people with dementia

2015 ◽  
Vol 9 (3) ◽  
pp. 212 ◽  
Author(s):  
Eleonora Meloni ◽  
Davide Liborio Vetrano ◽  
Roberto Bernabei ◽  
Graziano Onder
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Cognitive Deficits ◽  
The Elderly ◽  
Inappropriate Drug ◽  
Limited Life Expectancy ◽  
Inappropriate Drugs ◽  
People With Dementia ◽  
Limited Life

Dementia is associated with a number of comorbidities often observed in older people, including hypertension, cardiovascular disease, stroke and diabetes. Treating these comorbidities in older adults with dementia results challenging for many reasons. First, older adults with dementia are generally excluded from clinical trials, so application of clinical guidelines for treatment of chronic diseases in this population might lead to polypharmacy and adverse drugs effects. Second, memory, intellectual function, judgment and language are commonly impaired in patients with cognitive deficits, compromising the compliance to complex pharmacological regimens, increasing the risk of adverse drug reactions. Third, cognitive impairment is associated with limited life expectancy and therefore limits the efficacy of pharmacological treatments and questions the appropriateness of treatment. In the present study we examine most relevant concerns related to the treatment of comorbidities in demented patients, referring also to the existing criteria for inappropriate drugs in the elderly. The application of such instruments, along with the comprehensive geriatric assessment of the older adult with cognitive impairment, could result useful to reduce the burden of polypharmacy and inappropriate drug prescriptions.

scholarly journals Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Agnieszka Kułak-Bejda ◽  
Grzegorz Bejda ◽  
Napoleon Waszkiewicz
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Older People ◽  
Mood Disorders ◽  
The Elderly ◽  
Increased Risk ◽  
The World

More than 600 million people are aged 60 years and over are living in the world. The World Health Organization estimates that this number will double by 2025 to 2 billion older people. Suicide among people over the age of 60 is one of the most acute problems. The factors strongly associated with suicide are mentioned: physical illnesses, such as cancer, neurologic disorder, pain, liver disease, genital disorders, or rheumatoid disorders. Moreover, neurologic conditions, especially stroke, may affect decision-making processes, cognitive capacity, and language deficit. In addition to dementia, the most common mental disorders are mood and anxiety disorders. A common symptom of these disorders in the elderly is cognitive impairment. This study aimed to present the relationship between cognitive impairment due to dementia, mood disorders and anxiety, and an increased risk of suicide among older people. Dementia is a disease where the risk of suicide is significant. Many studies demonstrated that older adults with dementia had an increased risk of suicide death than those without dementia. Similar conclusions apply to prodromal dementia Depression is also a disease with a high risk of suicide. Many researchers found that a higher level of depression was associated with suicide attempts and suicide ideation. Bipolar disorder is the second entity in mood disorders with an increased risk of suicide among the elderly. Apart from suicidal thoughts, bipolar disorder is characterized by high mortality. In the group of anxiety disorders, the most significant risk of suicide occurs when depression is present. In turn, suicide thoughts are more common in social phobia than in other anxiety disorders. Suicide among the elderly is a serious public health problem. There is a positive correlation between mental disorders such as dementia, depression, bipolar disorder, or anxiety and the prevalence of suicide in the elderly. Therefore, the elderly should be comprehensively provided with psychiatric and psychological support.

scholarly journals Strategies to Improve Health Technologies for Older Adults With Cognitive Impairment and Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 862-862
Author(s):  
Stacey Schepens Niemiec ◽  
Elissa Lee ◽  
Jeanine Blanchard ◽  
Adam Strizich
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Cognitive Deficits ◽  
Technology Use ◽  
Community Organization ◽  
Digital Health ◽  
Health Technologies ◽  
Partner Involvement ◽  
Improve Health

Abstract Technology may improve health self-management of older people with cognitive deficits, yet these individuals may have unique needs influencing its utility. This study’s purpose was to gather current strategies described in the literature and by expert stakeholders for utilizing digital health technologies in older adults with cognitive impairment (CI) or dementia. We conducted a rapid literature review to identify articles that featured digital health technology use in persons with CI/dementia. Additionally, we conducted interviews (n=12) with expert stakeholders who were identified through online academic, professional, and community organization biographies and snowball referral. Qualitative-based thematic analysis was used to identify emergent themes from selected literature and transcribed interviews. Recommended strategies addressed instructional methods (e.g., reducing distractions), technology adaptations (e.g., simplified interface), care partner involvement, and dosage/exposure. Findings are applicable to development of technology-driven interventions and products, with the aim of improving the effectiveness of such technology for older people with CI/dementia.

scholarly journals End of life care for frail older people; do we have a consensus guideline on deprescribing?

2021 ◽  
Author(s):  
Arjun Poudel ◽  
Shakti Shrestha ◽  
Anna Lukacisinova ◽  
Lisa Nissen
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Frail Older People ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Medication Appropriateness

Background: Deprescribing interventions have shown to improve medication appropriateness in older people. However, the evidence on the actual benefits and risks of deprescribing in older adults at the end of life are limited. Due to the lack of evidence on the safety and efficacy of medication in these populations, the most appropriate deprescribing approach is unclear. We aimed to conduct a narrative review of research on existing deprescribing guidelines targeted to frail older people at the end of life. Methods: A literature search was conducted in PubMed, Embase, CINAHL and Google Scholar to identify studies from inception to January 2021 on deprescribing guidelines/tools for frail older adults near end-of-life or palliative situation or life-limiting illnesses or limited life expectancy were included. Results: A total of nine studies were included. The deprescribing guidelines used in these studies were helpful to some extent in optimising medications in patients with limited life expectancy and life-limiting illnesses. Some of them have been tested in prospective studies that showed their usefulness in minimising the number of potentially inapproapriate medications. These studies however were not randomised and involved small sample sizes and had little insight into the clinical outcomes of using these tools. Conclusions: The existing tools and guidelines on deprescribing do not represent the end of life care nor address the medication appropriateness among individuals with a specific condition. An explicit and rigorous consensus-based guideline needs to be developed and tested in a well-designed clinical trial to measure clinically significant outcomes

scholarly journals Body mass index and mild cognitive impairment among rural older adults in China: the moderating roles of gender and age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yemin Yuan ◽  
Jie Li ◽  
Nan Zhang ◽  
Peipei Fu ◽  
Zhengyue Jing ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older People ◽  
Older Women ◽  
Older Men ◽  
Gender And Age ◽  
Low Bmi ◽  
Rural Older Adults

Abstract Background Evidence concerning the association between body mass index (BMI) and cognitive function among older people is inconsistent. This study aimed to investigate gender and age as moderators in association between BMI and mild cognitive impairment (MCI) among rural older adults. Methods Data were derived from the 2019 Health Service for Rural Elderly Families Survey in Shandong, China. In total, 3242 people aged 60 years and above were included in the analysis. Multilevel mixed-effects logistic regression was used to examine the moderating roles of gender and age, then further to explore the relationship between BMI and MCI. Results There were 601 (18.5%) participants with MCI. Compared with normal BMI group, low BMI group had a higher risk of MCI among older people [adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.26–3.44], women (aOR = 2.06, 95% CI: 1.35–3.12), or the older elderly aged ≥75 years old (aOR = 3.20, 95% CI: 1.34–7.45). This effect remained statistically significant among older women (aOR = 3.38, 95% CI: 1.69–6.73). Among older men, elevated BMI group had a higher risk of MCI (aOR = 2.32, 95% CI: 1.17–4.61) than normal BMI group. Conclusions Gender and age moderated the association between BMI and MCI among Chinese rural older adults. Older women with low BMI were more likely to have MCI, but older men with elevated BMI were more likely to have MCI. These findings suggest rural community managers strengthen the health management by grouping the weight of older people to prevent the risk of dementia.

Interpersonal psychotherapy

2020 ◽  
pp. 261-264
Author(s):  
Philip Wilkinson ◽  
Ken Laidlaw
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Older People ◽  
Psychological Treatment ◽  
Interpersonal Psychotherapy ◽  
Evidence Base ◽  
Theory And Practice ◽  
Role Transitions ◽  
Treatment Of Depression

This chapter on interpersonal psychotherapy (IPT) describes the theory and practice of this structured psychological treatment. It discusses the implementation of IPT with older people. Next it reviews the applications of IPT with a main focus on the treatment of depression in older adults and distinguishes between the treatment of depression with and without cognitive impairment. It summarizes the structure of IPT and the use of specific techniques, and it then addresses the main therapeutic foci encountered in treatment (grief, interpersonal role disputes, role transitions, and interpersonal deficits). Finally, it briefly reviews the evidence base for IPT with older people.

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.

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.

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

2019 ◽  
Vol 32 (1) ◽  
pp. 97-104
Author(s):  
Pei-Chao Lin ◽  
Li-Chan Lin ◽  
Hsiu-Fen Hsieh ◽  
Yao-Mei Chen ◽  
Pi-Ling Chou ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Retrospective Study ◽  
Older People ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
Urban Setting ◽  
Research Database ◽  
Patient Records ◽  
People With Dementia

ABSTRACTObjectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

Abuse of people with dementia

2009 ◽  
Vol 19 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Amber Selwood ◽  
Claudia Cooper
Keyword(s):  
Older Adults ◽  
General Population ◽  
Older People ◽  
Memory Impairment ◽  
Social Care ◽  
Care Recipient ◽  
People With Dementia ◽  
Health And Social Care ◽  
Vulnerable People ◽  
With Memory

SummaryPeople with dementia are particularly vulnerable to abuse. It is inherently difficult to study as it is a hidden offence, perpetrated against vulnerable people with memory impairment, by those on whom they depend. In the general population, 6% of older people have experienced abuse in the last month and this rises to approximately 25% in vulnerable populations such as people with dementia. We know that various factors in the carer and the care recipient can predispose to a higher rate of abuse and this knowledge can be harnessed to try and improve prevention. There are also valid and reliable scales available to help detect abuse in vulnerable older adults. All health and social care professionals have a responsibility to act on any suspicion or evidence of significant abuse or neglect in order to ensure that appropriate management is taken.

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