Diabetes In Elderly May Be Overtreated Leading To Hypoglycemia

MedicalResearch.com Interview with:

Matthew L. Maciejewski, PhD Professor in Medicine Division of General Internal Medicine, Department of Medicine Center for Health Services Research Primary Care Durham VA Medical Center Duke University

Dr. Maciejewski

Matthew L. Maciejewski, PhD
Professor in Medicine
Division of General Internal Medicine, Department of Medicine
Center for Health Services Research Primary Care
Durham VA Medical Center
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Treating diabetes requires balancing the risks of long-term harm from under-treatment with the short-term and long-term harm from potential over-treatment. Randomized trials have shown that the benefits of aggressive glycemic control only begin after at least 8 years of treatment. Yet, the harms of aggressive glycemic control –  hypoglycemia, cardiovascular events, cognitive impairment, fractures, and death – can happen at any time.

In some older people, “deintensification” of diabetes treatment may be the safer route, because of the risks that come with too-low blood sugar. The American Geriatrics Society (AGS) specifically states that medications other than metformin should be avoided when an older patient’s hemoglobin A1c is less than 7.5%, because the risks of hypoglycemia are larger and the potential benefits of treatment are smaller for older adults with diabetes.  Most attention in prior work has focused on undertreatment of diabetes and there has been only limited investigation of patient characteristics associated with overtreatment of diabetes or severe hypoglycemia.

Since the elderly are therefore at greatest risk of overtreatment and Medicare is the primary source of care of the elderly, we examined rates of overtreatment and deintensification of therapy for Medicare beneficiaries, and whether there were any disparities in these rates.  We found that almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months.

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Group-Based Exercise Program Improves Mobility in Geriatric Population

MedicalResearch.com Interview with:

Jennifer Brach, Ph.D., P.T. Associate professor, Department of physical therapy School of Health and Rehabilitation Sciences University of Pittsburgh

Dr. Brach

Jennifer Brach, Ph.D., P.T.
Associate professor, Department of physical therapy
School of Health and Rehabilitation Sciences
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study compared two different group exercise programs to improve mobility in community-dwelling older adults. The first program, a seated program focused on strength, endurance and flexibility, was based on usual care. The second program, called On the Move, was conducted primarily in standing position and focused on the timing and coordination of movements important for walking. Both programs met two times per week for 12 weeks. It was found that the On the Move program was more effective at improving mobility than the usual seated program.

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Apathy Is a Risk Factor for Mortality in Nursing Home Patients

MedicalResearch.com Interview with:
Johanna MH Nijsten, Msc
Clinical Neuropsychologist
Archipel Landrijt, Knowledge Center for Specialized Care
Eindhoven, the Netherlands
Department of Primary and Community Care, Radboudumc Alzheimer Center
Radboud University Medical Center
Nijmegen, the Netherlands 

MedicalResearch.com: What is the background for this study?

Response: Apathy is common in nursing home (NH) patients with dementia and is repeatedly found to be the most prevalent neuropsychiatric symptom. Apathy is defined by diminished or lack of motivational, goal-directed behavior, and a lack of cognition and emotional affect. Apathy leads to reduced interest and participation in the main activities of daily living, diminished initiative, early withdrawal from initiated activities, indifference, and flattening of affect.

Over the last two decades, more scientific knowledge has become available about specific fronto-subcortical systems in the brain that may be highly involved in apathy. Disruptions in these systems are found in patients with frontal lobe damage resulting from, for instance, (early-onset) dementia, traumatic brain injury, stroke, or multiple sclerosis. Fronto-subcortical circuits also play an important role in neurological disorders involving the basal ganglia such as Parkinson’s disease and Huntington’s disease. The neurodegenerative diseases and acquired brain injuries mentioned here are highly prevalent in patients receiving long-term NH care and the widespread clinical manifestation of apathy in NH-patients is thought to be related.

Since apathy is very common in nursing home-patients and may lead to a poor prognosis, clear insight into its risk for mortality is needed and NH-staff need to understand this risk.

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Patient Proxies Increasingly Important As Health Care Fragments

MedicalResearch.com Interview with:

Dr. Joan Teno, MD MD Cambia Palliative Care Center of Excellence Seattle, WA

Dr. Teno

Dr. Joan Teno, MD MD
Cambia Palliative Care Center of Excellence
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our interest is understanding how continuity of care has changed with the eventual goal of understanding the impact on quality of care.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Make sure you have a proxy. Choose your proxy carefully.  In this era of health silos and multiple heath care professionals  involved in your care at each silo, it is important to have an advocate make sure that you get your care that you need and want.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Is this changing patterns of care that frail, older persons with multiple chronic illness care is in the hands of multiple health care professionals that practice in silos of health care providing high quality of care?

No disclosures

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Teno JM, Gozalo PL, Trivedi AN, Mitchell SL, Bunker JN, Mor V. Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014. JAMA Intern Med. Published online July 10, 2017. doi:10.1001/jamainternmed.2017.2136

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

Beta Blockers Linked To Increased Risk of Falls

MedicalResearch.com Interview with:
Dr. Nathalie van der Velde

Internist-Geriatrician
Erasmus MC
Rotterdam
The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In older persons, falls are the leading cause of injuries and often an adverse-drug reaction is involved. By lowering medication-related fall risk, loss of quality of life, institutionalization, and death can be prevented. Nevertheless, for optimal medication-withdrawal in clinical practice, better understanding of medication-related fall risk is essential, especially for the group of cardiovascular drugs, as previous studies showed contradictory results. Therefore, the objective of our study was to assess whether specific drug characteristics determine beta-blocker related fall risk, a frequently prescribed cardiovascular drug.

Our study showed that fall risk was increased in users of non-selective beta-blockers. This was not the case for overall use of beta-blockers or other drug characteristics (lipid solubility, intrinsic sympathetic activity and CYP2D enzyme metabolism).

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Many Older Adults Welcome A Stop To Cancer Screenings

MedicalResearch.com Interview with:

Nancy Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine

Nancy Schoenborn, MD
Assistant Professor
Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine

MedicalResearch.com: What are the main findings?

Response: A lot of cancer screenings are not expected to save lives until up to 10 years later; however, the side effects of the test happen right away. Because of this, clinical guidelines have recommended against routine screening for those patients who will not live long enough to benefit but may experience the potential harm of the test in the short term. However, many patients with limited life expectancy still receive screening and clinicians are worried about how patients would react if they recommended that patients stop screening. This research is important because it is the first study that explores how patients think about the decision of stopping cancer screening and how patients want to talk to their doctors about this issue. Understanding patient perspectives would help improve screening practices and better align recommendations and patient preference.

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People Who Live To 100 Do So With Fewer Chronic Illnesses

MedicalResearch.com Interview with:

Raya Elfadel Kheirbek, MD, MPH Geriatrician and Palliative Care Physician  Washington DC VA Medical Center  Associate Professor of Medicine  George Washington University  School of Medicine and Health Sciences

Dr. Raya Elfadel Kheirbek

Raya Elfadel Kheirbek, MD, MPH
Geriatrician and Palliative Care Physician
Washington DC VA Medical Center
Associate Professor of Medicine
George Washington University
School of Medicine and Health Sciences

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the past decade, there has been a shift in the concept of successful aging from a focus on life span to health span. We all want to age gracefully “expecting” optimal health, quality of life and independence.

Centenarians are living examples to the progress we have made in health care. They are the best example of successful aging since they have escaped, delayed or survived the major age-related diseases and have reached the extreme limit of human life. However, little is known about Veterans Centenarians’ incidence of chronic illness and its impact on survival.

Utilizing the VA Corporate Data Warehouse (CDW), I worked with my colleagues’ researchers and identified 3,351 centenarians who were born between 1910 and 1915. The majority were white men who served in World War II and had no service related disability. The study found that 85 % of all the centenarians had no incidence of major chronic conditions between the ages of 80 and 99 years of age. The data demonstrate that Veteran centenarians tend to have a better health profile and their incidence of having one or more chronic illness is lower than in the general population.

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Microvascular Disease Linked To Late-Life Depression

MedicalResearch.com Interview with:

Miranda T. Schram PhD Associate professor Department of Medicine Maastrich

Dr. Schram

Miranda T. Schram PhD
Associate professor
Department of Medicine
Maastrich

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Late-life depression, also called vascular depression, is highly prevalent, recurrent and difficult to treat. Anti-depressants only relieve symptoms in about 50% of the patients. So we urgently need new treatment targets for this disease.

In this study we found that microvascular dysfunction, irrespective if you measure this by biomarkers in the blood or in the brain, is associated with an increased risk for depression. Moreover, we found evidence from longitudinal studies that microvascular dysfunction, at least of the brain, may actually be a cause of depression. To investigate this, we undertook a meta-analyses of data from over 40,000 individuals of whom over 9,000 had a depression.

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Modified Hospital Elder Life Program Reduces Post-Op Delirium and Length of Stay

MedicalResearch.com Interview with:
Cheryl Chia-Hui Chen, RN, DNSc

Vice Dean for Student Affairs
Professor of Nursing
National Taiwan University
Nurse Supervisor at National Taiwan University Hospital
Taipei, Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older patients undergoing abdominal surgery often experience preventable delirium, which greatly influences their postoperative recovery and hospital length of stay. The modified Hospital Elder Life Program (mHELP) utilizes nurses to reduce postoperative delirium and LOS among older patients undergoing abdominal surgery for resection of malignant tumor. The mHELP consisted of 3 protocols: oral and nutritional assistance, early mobilization, and orienting communication, researchers say.

Researchers at the National Taiwan University Hospital randomly assigned 377 patients undergoing abdominal surgery for a malignant tumor to an intervention (n = 197) or usual care (n = 180).

Postoperative delirium occurred in 6.6 percent of mHELP participants vs 15.1 percent of control individuals (odds of delirium reduced by 56 percent). Intervention group participants received the mHELP for a median of 7 days, and they had a median LOS that was two days shorter (12 vs 14 days).

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May Be No Benefit To Statins For Primary Prevention in Older Adults

MedicalResearch.com Interview with:
Benjamin Han, MD, MPH
Assistant professor
Departments of Medicine-Division of Geriatric Medicine and Palliative Care, and Population Health
NYU Langone Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are an increasing number of older adults being prescribed statins for primary prevention, but the evidence for the benefit for older adults is unclear.

Our study finds that in the ALLHAT-LLT clinical trial, there were no benefits in either all-cause mortality or cardiovascular outcomes for older adults who did not have any evidence of cardiovascular disease at baseline.

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