Deprescribing Antidepressants in Older People – Breaking Up Can Be Hard to Do

2021 ◽  
Vol 36 (5) ◽  
pp. 228-237
Author(s):  
Dee Mangin ◽  
Henry Y.H. Siu
Keyword(s):  
Older People ◽  
Substantial Proportion ◽  
Evidence Based ◽  
Older Person ◽  
Potential Benefits ◽  
Stopping Treatment ◽  
Potential Risks ◽  
Specific Potential ◽  
Drug Review

Every drug review for older people should consider which medicines to continue, but equally important, which medicines can be discontinued. As we age, the balance between potential benefits and potential risks of medications often shifts towards more harm. For example, antidepressants are commonly prescribed in general, but in the older person, they carry specific potential harms. Further, there is data indicating that a substantial proportion of users have no evidence-based indications to continue antidepressants and could be candidates to try stopping treatment. We outline first the imperatives and evidence for deprescribing antidepressants and then finally the practical approaches to deprescribing.

Designing for older people: But who is an older person?

2016 ◽  
Author(s):  
Raghavendra Reddy Gudur ◽  
◽  
Alethea Blackler ◽  
Vesna Popovic ◽  
Doug Mahar
Keyword(s):  
Older People ◽  
Older Person

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

Socialising Disease: Medical Categories and Inclusion of the Aged

2000 ◽  
Vol 48 (3) ◽  
pp. 383-407 ◽  
Author(s):  
Joanna Latimer
Keyword(s):  
Older People ◽  
Hospital Care ◽  
Social Inclusion ◽  
Social Problems ◽  
Older Person ◽  
Medical Unit ◽  
Life Chances ◽  
Acute Medical Unit ◽  
Medical Domain

When older peoples' troubles are categorised as social rather than medical, hospital care can be denied them. Drawing on an ethnography of older people admitted as emergencies to an acute medical unit, the article demonstrates how medical categories can provide shelter for older people. By holding their clinical identity on medical rather than social grounds, physicians who specialise in gerontology in the acute medical domain can help prevent the over-socialising of an older person's health troubles. As well as helping the older person to draw certain resources to themselves, such as treatment and care, this inclusion in positive medical categories can provide shelter for the older person, to keep at bay their effacement as ‘social problems'. These findings suggest that contemporary sociological critique of biomedicine may underestimate how medical categorising, as the obligatory passage through which to access important resources and life chances, can constitute a process of social inclusion.

scholarly journals Reframing Aging in Contemporary Politics: Building Momentum

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 681-681
Author(s):  
Patricia D'Antonio
Keyword(s):  
Social Change ◽  
Older People ◽  
Evidence Based ◽  
Negative Attitudes ◽  
Attitudes And Behaviors ◽  
Contemporary Politics ◽  
Perceptions Of Aging ◽  
The Many ◽  
Changing Attitudes

Abstract Changing American culture is challenging and changing attitudes and behaviors around the universal experience of aging especially so. Unless the field of advocates who care about aging issues cultivates a more visible, more informed conversation on older people, it will remain difficult to advance the systemic changes needed to adjust to a society with increased and increasing longevity. Advocates will need to be vigilant to avoid cueing negative attitudes towards aging and aging policies. The Reframing Aging Initiative is a long-term, social change endeavor designed to improve the public’s understanding of what aging means and the many contributions older people bring to society. Using evidence-based research, the initiative seeks to teach advocates how to tell an effective story about aging that will promote positive perceptions of aging and reduce ageism. The time to change the conversation is now.

scholarly journals Evidence-Based Chinese Medicine for Hypertension

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Jie Wang ◽  
Xingjiang Xiong
Keyword(s):  
Chinese Medicine ◽  
Tai Chi ◽  
Clinical Evidence ◽  
Poor Quality ◽  
Evidence Based ◽  
Hypertensive Patients ◽  
Primary Endpoints ◽  
Potential Benefits ◽  
Public Health Challenge

Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM). Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go.

scholarly journals Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

2016 ◽  
Vol 13 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Nienke Bleijenberg ◽  
Valerie H. ten Dam ◽  
Irene Drubbel ◽  
Mattijs E. Numans ◽  
Niek J. de Wit ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Care Program ◽  
Treatment Fidelity ◽  
Evidence Based ◽  
Primary Care Program

Draw a Young and an Older Person: Schoolchildren's Images of Older People

2012 ◽  
Vol 38 (12) ◽  
pp. 827-840 ◽  
Author(s):  
Feliciano Villar ◽  
Josep Fabà
Keyword(s):  
Older People ◽  
Older Person

Medication review for the older person

2007 ◽  
Vol 17 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Maggi Banning
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Drug Dose ◽  
Inappropriate Drug ◽  
Older Person ◽  
Duration Of Treatment ◽  
Chronic Morbidity ◽  
Effects Of Aging ◽  
The Impact ◽  
Repeat Prescriptions

People of 65 years and older accounted for 21% of the population of England and Wales in 2001, and their proportion is increasing. It is forecast that the number of people over the age 75 years will double within the next 50 years, and that of those over the age of 90 will increase fivefold. The older patient with declining health poses significant challenges for health care professionals, in particular those of managing chronic morbidity and the effects of aging. Many older people require pharmacological treatment for multiple, co-existing pathologies. Those of 65 years and over receive 56% of all prescriptions in England, of which 78% are repeat prescriptions, and people in residential care, on average, receive five different medicines concurrently. The impact of repeat prescriptions means that, due to inadequate monitoring, many older people continue to administer medicines they no longer require, and thereby risk receiving an inappropriate drug, dose or duration of treatment. In addition to this, there is the propensity for older people to mismanage medicines, increasing their risk of unplanned drug-related admission to hospital and drug-related morbidity.

scholarly journals Patients’ perception about the outcomes of prosthetic treatment in Southern Brazil

2020 ◽  
Vol 19 ◽  
pp. e209398
Author(s):  
Giseli Sauer Benetti ◽  
Lara Dotto ◽  
Angélica Maroli ◽  
Fabíola Barbon ◽  
Alfonso Sanchez-Ayala ◽  
...  
Keyword(s):  
Significant Influence ◽  
Education Level ◽  
Prior Treatment ◽  
Southern Brazil ◽  
Negative Perception ◽  
Sociodemographic Data ◽  
Initial Appointment ◽  
Potential Benefits ◽  
Potential Risks ◽  
The City

Aim: this study assessed the patients’ perception of the outcomes of prosthetic treatment in a University of Southern Brazil. Methods: patients seeking for prosthetic treatment were invited to answer a questionnaire with 41 items about the potential risks, benefits, and consequences of no treatment. Answers were obtained according to a five-item Likert-scale varying from 1 (completely disagree) to 5 (completely agree). Sociodemographic data was included in the comparison. Mann-Whitney or Kruskal-Wallis (95%) compared data depending on the variable. Results: two-hundred twenty-five patients answered the questionnaire. Median age of participants was 45-54 years. The potential benefits were similar among participants irrespective of the variable adopted. The perception of risks was significant influenced by variables gender, age, education level, type of edentulous space, prior treatment with prosthodontics, type of prosthodontics, and prosthodontics usage in years. Consequences of no treatment were affected by age, prior treatment with prosthodontics, and prosthodontics usage in years. Conclusions: the study showed the fundamental importance of correct elucidation about the potential risks (negative perception) in the initial appointment for the studied population. Elucidation about the consequences of no treatment are relevant because some differences were seen into the variables. Prosthodontics patients from the city of Passo Fundo seem well informed about the benefits of the prosthetic treatment, besides the significant influence of some sociodemographic and prosthetic conditions. 

Improving access to adult vaccination: a tool for healthy ageing

2014 ◽  
Vol 18 (2) ◽  
pp. 58-66 ◽  
Author(s):  
Jonathan Scrutton ◽  
David Sinclair ◽  
Trinley Walker
Keyword(s):  
Older People ◽  
Group Discussion ◽  
Grey Literature ◽  
Healthy Ageing ◽  
Active Ageing ◽  
Content Type ◽  
Health And Social Care ◽  
Potential Benefits ◽  
The Government ◽  
The Uk

Purpose – The purpose of this paper is to demonstrate how access to vaccination for older people in the UK can be both improved and used as a tool for healthy ageing. Design/methodology/approach – ILC-UK released a report “Adult Immunisation in the UK”, which applied a UK perspective to a 2013 Supporting Active Ageing Through Immunisation (SAATI) report on immunisation. The ILC report combined the SAATI findings with a traditional literature review, a policy review incorporating grey literature and the outcomes of a focus group discussion. This paper highlights the key findings of the ILC-UK report. Findings – Vaccination needs to be included as part of proactive strategies to promote healthy and active ageing. Initiatives need to be explored that increase the rate of delivery of vaccinations. Barriers to the vaccination of health and social care professionals working with older people need to be removed. The government should explore using psychological insights into human behaviour to improve the take-up of vaccinations amongst adults. The range of settings where older people can receive vaccination needs to be expanded. Information on the potential benefits of immunisation should be made readily available and easily accessible to older people. Practical implications – The paper calls for a structural shift in how vaccination services in the UK are organised. Social implications – The paper calls for a cultural shift in how society views immunisation and the role it has to play in the healthy ageing process. Originality/value – The paper uses new European research on immunisation and applies it to the UK's situation.

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