Pharmacological Management of Hyperlipidemia in Older individuals

2021 ◽  
Vol 36 (6) ◽  
pp. 284-303
Author(s):  
Laura V. Tsu ◽  
Kacey Carroll ◽  
Katee Kindler ◽  
Nicole Early
Keyword(s):  
Older People ◽  
Data Extraction ◽  
Adult Population ◽  
The Elderly ◽  
Research Review ◽  
Original Research ◽  
Older Individuals ◽  
Pcsk9 Inhibitors ◽  
Pharmacological Management ◽  
Common Chronic Disease

OBJECTIVE: To provide an up-to-date review of current hyperlipidemia guidelines and discuss pharmacotherapeutic management of hyperlipidemia in older individuals. DATA SOURCES: A PubMed search of articles published through October 2020 was performed using a combination of the following words: older adults, hyperlipidemia, statin, ezetimibe, fibrate, fish oil, niacin, bile acid sequestrant, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of hyperlipidemia in the older individuals. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: Hyperlipidemia is a common chronic disease state in the elderly population, though there is limited evidence for clinical outcomes in older people when compared withwith the general adult population. Statins have the most evidence for primary and secondary prevention of cardiovascular disease in older people, though ezetimibe and PCSK9 inhibitors have a role as add-on or monotherapy in patients who do not tolerate statins. CONCLUSION: Optimal management of hyperlipidemia in older people is important in order to avoid further complications and improve outcomes. Pharmacists can help improve management in the elderly by incorporating up-to-date evidence from guidelines and providing medication education specifically for this population.

A Review of Clinical Guidelines and Pharmacotherapeutic Management of Hypertension in Older Adults

2019 ◽  
Vol 34 (2) ◽  
pp. 86-98
Author(s):  
Jelena Lewis ◽  
Tania Gregorian ◽  
Ashley M. Huntsberry ◽  
Laura V. Tsu
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Adverse Drug Events ◽  
Data Extraction ◽  
Adult Population ◽  
Research Review ◽  
Original Research ◽  
Blood Pressure Targets ◽  
Common Chronic Disease ◽  
Pubmed Search

OBJECTIVE: To provide an up-to-date review of current hypertension (HTN) guidelines and discuss pharmacotherapeutic management of HTN in the older adult population.<br/> DATA SOURCES: A PubMed search of articles published through June 2018 was performed using a combination of the following words: elderly, older adults, geriatric, and HTN.<br/> STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of HTN in older adults. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, complete results, and after a thorough discussion among the authors.<br/> DATA SYNTHESIS: HTN is a common chronic disease state in older adults. Until recently, most guidelines recommended a higher threshold for blood pressure targets in this population, compared with the general adult population. In 2017, two new guidelines for the management of HTN were published, which provided conflicting recommendations for blood pressure goals in the older population. This article reviews current U. S. HTN guidelines published in 2014 to 2017 that most commonly influence patient care, and it specifically addresses the blood pressure targets and pharmacotherapeutic management of HTN in older adults.<br/> CONCLUSION: Management of HTN in older adults is important to avoid further complications and improve outcomes in this population. Blood pressure targets and HTN management should be individualized in older adults based on comorbid conditions, life expectancy, and risk for adverse drug events.

scholarly journals Educational programmes for frail older people, their families, carers and healthcare professionals

2021 ◽  
Author(s):  
Rachel J. Viggars ◽  
Andrew Finney ◽  
Barnabas Panayiotou
Keyword(s):  
Health Promotion ◽  
Older People ◽  
Health Professionals ◽  
Data Extraction ◽  
Self Care ◽  
Cross Sectional Study ◽  
Older Individuals ◽  
Cross Sectional ◽  
Educational Programmes ◽  
Quasi Experimental

Summary Background More people are living with frailty and requiring additional health and support services. To improve their management, the “Frailty: Core Capability Framework” in the United Kingdom recommends frailty education for older individuals, their families, carers and health professionals. We performed a systematic review of specific educational programmes for these groups. Methods Electronic databases were searched using dedicated search terms and inclusion criteria. To improve accuracy, two reviewers carried out the screening and selection of research papers. Information from included studies was collected using a tailored data extraction template, and quality appraisal tools were used to assess the rigour of the studies. The findings were analysed to identify key themes. Results A total of 11 studies met the criteria and were included in the review. The study populations ranged from 12 to 603 and the research designs were heterogeneous (6 qualitative; 2 randomised controlled trials; 1 quasi-experimental; 1 mixed methods; 1 cross-sectional study). Whilst some methodological shortcomings were identified, all studies contributed valuable information. The results underwent narrative synthesis, which elucidated four thematic domains: (1) accessibility of educational programmes, (2) empowerment, (3) self-care, and (4) health promotion (especially exercise and nutrition). Conclusion Educational programmes for older people, their carers and health professionals are important for effective frailty prevention and management. To be maximally beneficial, they should be easily accessible to all target populations and include empowerment, self-care and health promotion. Further research should explore the formulation of widely applicable, user-friendly programmes and delivery formats that can be tailored to different client groups.

TIME PERSPECTIVE PERCEPTION SPECIFIC AND MALADAPTATION IN ELDERLY UNDER UNCERTAINTY CONDITIONS DURING PANDEMIC EMERGENCY

2021 ◽  
pp. 672-678
Author(s):  
А.В. Васильева ◽  
Р.И. Антохина ◽  
Е.Ю. Антохин
Keyword(s):  
Older People ◽  
Psychological Stress ◽  
Time Perspective ◽  
Comparison Group ◽  
Adult Population ◽  
The Elderly ◽  
Adaptive Capabilities ◽  
Age Factor ◽  
Perception Of Time ◽  
Adaptive Resource

Цель исследования - определение специфики переживания психологического стресса, временной перспективы и симптоматики адаптационных нарушений у пожилых людей в чрезвычайной ситуации пандемии по сравнению с активным взрослым населением. На первом этапе были обследованы 587 человек с помощью шкалы PSM-25, затем были отобраны 100 респондентов с дезадаптационным уровнем стресса (сумма ≥155 баллов). Основную группу составили 50 человек 60-74 лет (средний возраст - 65±2,7 года), 50 человек 18-44 лет (средний возраст - 32±3,8 года) вошли в группу сравнения, которые были обследованы с помощью опросника SCL-90-R для оценки психопатологической симптоматики и опросника ZTPI для оценки восприятия временной перспективы. Выявлено наличие адаптационных расстройств в обеих группах. В группе пожилых установлена активация восприятия позитивного прошлого, что может быть адаптационным ресурсом, и большая выраженность фаталистического восприятия настоящего, что обусловливает пассивное преодоление стресса и сужает адаптационные возможности пожилых людей. Результаты исследования позволяют обозначить потенциальные «мишени» психотерапевтической работы с населением в условиях пандемического стресса с учетом возрастного фактора. The purpose of the study - to determine the specifics of experiencing psychological stress, the time perspective and symptoms of adaptation disorders in older people in a pandemic emergency compared to the active adult population. At the first stage, 587 people were examined using the PSM-25 scale, then 100 respondents with maladaptive stress levels (sum ≥155 points) were selected. The main group consisted of 50 people aged 60 to 74 years (aver age age 65±2,7 years), 50 people aged 18 to 44 years (average age 32±3,8 years) were included in comparison group, who were examined with using the SCL-90-R questionnaire for assessing psychopathological symptoms and the ZTPI questionnaire for assessing the perception of time perspective. The presence of adaptation disorders in both groups was revealed. In the elderly group, the activation of the perception of the positive past was established, which can be an adaptive resource, and the greater severity of the fatalistic perception of the present, which causes passive overcoming with stress and narrows the adaptive capabilities of the elderly. The results of the study make it possible to identify potential «targets» of psychotherapeutic work with the population in conditions of pandemic stress, taking into account the age factor.

scholarly journals Older people at risk in times of pandemic? A qualitative study of coping narratives that support resilience in older people

2021 ◽  
Author(s):  
Lucía Pérez Sánchez ◽  
Beatriz Guadalupe Maza Pérez ◽  
Guiana Fernández De Lara López Fernández De Lara López
Keyword(s):  
At Risk ◽  
Older People ◽  
Old Age ◽  
Adult Population ◽  
Continuous Process ◽  
Psychological Impact ◽  
The Elderly ◽  
Coping Resources ◽  
World Health ◽  
Cross Sectional

Background: The World Health Organization mentions that the stress that COVID-19 triggers and confinement are causing a strong psychological impact on societies, due to the relationship made of the binomial pandemic and death. The above exposes the political scenario of COVID-19 for the elderly that once again exhibits the image of the elderly as fragile beings, incapable of thinking and deciding for themselves, who must be cloistered and isolated. However, despite the empirical evidence that shows a vulnerable and at-risk population in the context of the current pandemic, other theoretical views differ and emphasize the strengths that are manifested in this stage of life. Objective: To understand the narrative construction and resilient processes that the older adult population has experienced concerning COVID-19. Special attention was paid to the discourse on psycho-emotional consequences, social beliefs about old age, discrimination, as well as the omissions of human rights and dignity of the elderly. Method: qualitative descriptive cross-sectional ethnomethodological design, with a continuous inclusion sample, corresponding to 15 participants, between 64 and 85 years old, living in Mexico. Results: It was identified that the participating older adults have sufficient psycho-emotional coping resources, due to the efficacy of the regulation of the feelings experienced. However, it is still influenced by the social perception of stereotypes and stigmatization. Conclusions: The results coincide with the postulates of positive psychology and psycho-gerontology regarding the development of capacities and potentialities as a continuous process, and that in older adulthood they become present, thanks to the accumulation of experiences, individual and collective. This underlines the importance of including other ways in which old age is lived and studied, and therefore in the methodologies and proposals for intervention.

scholarly journals Hypoglycaemia in older home-dwelling people with diabetes- a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Hermann ◽  
Lovise S. Heimro ◽  
Anne Haugstvedt ◽  
Ingvild Hernar ◽  
Arun K. Sigurdardottir ◽  
...  
Keyword(s):  
Health Care ◽  
Older People ◽  
Scoping Review ◽  
Emergency Situation ◽  
Developed Countries ◽  
Health Care Use ◽  
Original Research ◽  
Diabetes Knowledge ◽  
Older Individuals ◽  
Scoping Reviews

Abstract Background Hypoglycaemia is associated with cognitive and functional decline in older people with diabetes. Identification of individuals at risk and prevention of hypoglycaemia is therefore an important task in the management of diabetes in older home-dwelling individuals. The purpose of this scoping review was to map the literature on hypoglycaemia in home-dwelling older people with diabetes. Methods This scoping review included original research articles on hypoglycaemia in older (≥ 65 years) individuals with diabetes from developed countries. A broad search of the databases Cinahl, Embase and Medline was performed in July 2018. The report of the scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews. Results Our database search identified 577 articles of which 23 were eligible for inclusion. The identified literature was within four areas: 1) incidence of hypoglycaemia in older home-dwelling people with diabetes (11/23 articles), 2) risk factors of hypoglycaemia (9/23), 3) diabetes knowledge and self-management (6/23) and 4) consequences of hypoglycaemia for health care use (6/23). The majority of the literature focused on severe hypoglycaemia and the emergency situation. The literature on diabetes knowledge and management related to preventing adverse events relevant to older home-dwellers, was limited. We found no literature on long-term consequences of hypoglycaemia for the use of home health care services and the older persons’ ability to remain home-dwelling. Conclusions We identified a lack of studies on prevention and management of hypoglycaemia in the older individuals’ homes. Such knowledge is of utmost importance in the current situation where most western countries’ governmental policies aim to treat and manage complex health conditions in the patient’s home. Future studies addressing hypoglycaemia in older individuals with diabetes are needed in order to tailor interventions aiming to enable them to remain home-dwelling as long as possible.

The Role of Docusate for Constipation in Older People

2021 ◽  
Vol 36 (10) ◽  
pp. 501-507
Author(s):  
Timothy Nguyen
Keyword(s):  
Randomized Controlled Trial ◽  
Older People ◽  
Older Adult ◽  
Health Care Providers ◽  
Chronic Constipation ◽  
Data Extraction ◽  
Controlled Trial ◽  
Adult Population ◽  
Care Providers ◽  
Randomized Controlled

Objective: To provide brief information on the effectiveness of docusate use for constipation in older people. Data Sources: PubMed search using the following terms (“docusate and chronic constipation,” “docusate, chronic constipation and geriatric,” “docusate, chronic constipation and older adult,” “docusate and randomized controlled trial” and included relevant information related to docusate and chronic constipation in the population described. Study Selection: Studies that fit the criteria for “chronic/general constipation,” “geriatric/older adults,” and/or “randomized controlled trials” were included. Four studies described docusate for chronic/general constipation and older people. Not included were other studies not related to chronic/general constipation and older people (eg, surgery-related). Data Extraction: Data extraction from each study included primary outcomes related to chronic constipation and efficacy of docusate. Data also included relevant reports from other relevant trials and discussions. Data Synthesis: Docusate when compared with placebo or psyllium or sennosides in these trials did not show any benefits for constipation. Psyllium and sennosides showed to be more effective compared with docusate. No differences found between docusate versus placebo. In summary, there is a lack of data to support the use of docusate for constipation and the data presented that docusate is not effective for use in constipation. Conclusion: Docusate is commonly used for constipation despite little evidence supporting its efficacy. There is not enough randomized controlled trial and data to support the use of docusate for constipation. Pharmacists along with health care providers should reassess and reconsider whether to use it and add extra layers to an already complex medication regimen in the older adult population.

Non-pharmacological management of orthostatic hypotension in the elderly patient

2005 ◽  
Vol 15 (3-4) ◽  
pp. 165-173 ◽  
Author(s):  
Chie Wei Fan ◽  
Conal J Cunningham
Keyword(s):  
Blood Pressure ◽  
Elderly Patient ◽  
Pressure Drop ◽  
Older People ◽  
Systolic Blood Pressure ◽  
Orthostatic Hypotension ◽  
Supine Position ◽  
The Elderly ◽  
Common Condition ◽  
Pharmacological Management

Orthostatic hypotension (OH) is defined as a systolic blood pressure (SBP) drop of at least 20 mmHg, or a diastolic blood pressure drop of at least 10 mm Hg within three minutes of standing from a supine position. It can be symptomatic or asymptomatic and is a common condition that can affect up to one in three older people living in the community. The prevalence is higher amongst those with Parkinson's disease and, unsurprisingly, amongst those attending a syncope clinic. The aetiology and pathophysiology of OH have been comprehensively discussed in a previous article in this journal.

scholarly journals Cognitive toxicity of drugs used in the elderly

2001 ◽  
Vol 3 (3) ◽  
pp. 181-190
Keyword(s):  
Cognitive Impairment ◽  
Adverse Effects ◽  
Older People ◽  
The Elderly ◽  
Heterogeneous Population ◽  
Older Individuals ◽  
Wide Range ◽  
Cognitive Disturbances ◽  
Toxicity Of Drugs ◽  
Package Labeling

The aged are an extremely heterogeneous population that is growing worldwide, included are healthy and agile individuals in their early sixties, as well as an increasing number of people over the age of 35. Pharmacotherapy is expected to continue its prominent role in the medical management of a wide range of conditions that affect older people. Adverse consequences of all kinds complicate the use of medications, and such events seem to increase in incidence with polypharmacy. Cognitive impairment can occur during the course of treatment with a wide range of medications and can have a variety of presentations, Both the number of concurrent medications that older individuals routinely use and physiologic changes in these patients render them more susceptible to developing cognitive toxicity. Most of the frequently implicated medications carry documentation of their ability to cause cognitive disturbances in their package labeling, suggesting that the level of vigilance for adverse effects during the course of their use should always be high. Such caution can be used to guide appropriate drug treatment of the aged so that clinicians do not need to opt for undertreatment to avoid toxicity.

scholarly journals Diversity in health professional education scholarship: a document analysis of international author representation in leading journals

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e043970
Author(s):  
Brittany Buffone ◽  
Ilena Djuana ◽  
Katherine Yang ◽  
Kyle J Wilby ◽  
Maguy S El Hajj ◽  
...  
Keyword(s):  
Health Professional ◽  
Professional Education ◽  
Teaching And Learning ◽  
Western Europe ◽  
English Language ◽  
Data Extraction ◽  
Document Analysis ◽  
Original Research ◽  
Health Professional Education ◽  
Eligibility Criteria

ObjectivesThe global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives.DesignWe conducted a document analysis to examine authorship of recent publications to explore current international representation.Data sourcesThe table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase.Eligibility criteriaThe journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis.Data extraction and synthesisThe table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable).ResultsA total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time.ConclusionsDiversity in health professional education scholarship, as marked by nation of authors’ professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

scholarly journals Health insurance awareness and its uptake in India: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043122
Author(s):  
Bhageerathy Reshmi ◽  
Bhaskaran Unnikrishnan ◽  
Shradha S Parsekar ◽  
Eti Rajwar ◽  
Ratheebhai Vijayamma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Insurance ◽  
Data Extraction ◽  
Adult Population ◽  
Social Science Research ◽  
Healthcare Utilisation ◽  
Science Research ◽  
Research Network ◽  
Universal Healthcare ◽  
Government Websites

IntroductionHealth insurance is one of the important approaches that can help in boosting universal healthcare coverage through improved healthcare utilisation and financial protection. This objectives of this review are to identify various interventions implemented in India to promote awareness of health insurance, and to provide evidence for the effectiveness of such interventions on the awareness and uptake of health insurance by the resident Indian population.Methods and analysisA systematic review will be carried out based on the Cochrane handbook for systematic reviews of interventions. The review will include experimental and analytical observational studies that have included adult population (>18 years) in India. We will include any intervention, policy or programme that directly or indirectly affects awareness or uptake of health insurance. The following outcomes will be eligible to be included: awareness or health insurance literacy, attitude such as readiness to buy health insurance or decision making, uptake of health insurance, demand-side and supply-side factors for awareness of health insurance, and awareness as a factor for uptake and re-enrolment in health insurance. Databases such as MEDLINE (PubMed), Web of Science, Scopus, 3ie impact evaluation repository and Social Science Research Network will be searched from January 2010 to 15 July 2020. Additionally, important government websites and references of the included studies will be scanned to identify potential records. Three authors, independently, will carry out screening and data extraction. Studies will be categorised into quantitative and qualitative, and mixed-methods synthesis will be employed to analyse the findings.Ethics and disseminationThis review will be based on published studies and will not recruit human participants directly, therefore, ethical clearance is not applicable. We will disseminate the final review findings in a national or international conference and publish in a peer-reviewed journal.

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