How to treat the frail elderly: The challenge of multimorbidity and polypharmacy

Tannenbaum, Cara

doi:10.5489/cuaj.1619

Cited by 11 publications

(8 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An additional reason may be that, unlike cardiovascular and metabolic diseases, there has been no clinical trial in this population of symptomatic, frail, elderly individuals, and thus, there is no evidence that any intervention proven to be effective in younger individuals with less severe disease is still effective in the elderly. This reinforces the urgent need for studies of this difficult population [26] and of patients with complex concomitant chronic diseases such as COPD and chronic heart failure [27].…”

mentioning

confidence: 76%

“…These are the most common chronic diseases responsible for dyspnoea [25,26]. They share important risk factors (ageing and smoking), often occur together, and both are often underdiagnosed and undertreated, particularly in the elderly [25,26].…”

mentioning

confidence: 99%

“…These trials are very difficult to design but, for chronic diseases in general and for frail, elderly patients in particular, we urge our fellow investigators to move out of the single-disease model and to address the complexity of these patients and their pharmacological and nonpharmacological management ( fig. 1) [26,29,30]. …”

mentioning

confidence: 99%

See 2 more Smart Citations

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

2014

View full text Add to dashboard Cite

@ERSpublicationsEarly screening of chronic diseases and COPD needs attention in the elderly population to properly assess management http://ow.ly/ACbi3The working hypotheses for screening and early diagnosis of chronic obstructive pulmonary disease (COPD) have been that: 1) long-term exposure to cigarette smoke or pollutants damages the airways and/or the lungs, and causes airflow obstruction [1, 2]; 2) airflow obstruction occurs primarily in the small airways, is asymptomatic in the early stages of the disease and is progressive in the majority of COPD patients [1][2][3][4]; and 3) forced expiratory volume in 1 s (FEV1) and its ratio with forced vital capacity are necessary in establishing the diagnosis of COPD, and in assessing the excessive decline in lung function [1], but are of little use, if any, in making the early, pre-symptomatic diagnosis of COPD [5].These working hypotheses have been helpful in stimulating research in the field of structure-function relationships in the lung, and particularly in defining the role of airway and lung inflammation in the development of central and peripheral airway remodelling and emphysema [2, 3,6]. Research focused on the respiratory system has also brought about the development of physiological and imaging methods to assess peripheral airways and lung parenchyma [7][8][9], and has furthered understanding of the natural history of COPD, particularly the progressive decline in lung function and its modulation by pharmacological intervention [10]. Thanks to the results of these studies, we now know much more about COPD, about the potential and limitations of screening [11] and early diagnosis based on spirometry, and about interventions in early asymptomatic and newly discovered COPD.Screening subjects at risk, such as smokers, workers and populations exposed to environmental pollution, with serial measurements of FEV1 has been shown to identify COPD at an early stage, with a diagnostic yield that is significant even in asymptomatic individuals [12]. Studies including measurement of small airway function, though inconclusive, have been used in an attempt to identify more subtle changes in airway function, without success [5,13]. Novel imaging methods [8,9] and biomarker profiles [14,15] show promise, but we are not there yet. Consequently, a suitable alternative to spirometry has yet to be discovered. Spirometry is simple, inexpensive, and remains the best practical method for use in early detection and screening of undiagnosed airflow obstruction [16].The rationale for identifying subjects with previously undiagnosed COPD and for early diagnosis of COPD in subjects at risk is that it would benefit the patient, either because symptoms and quality of life would be improved, exacerbations and complications would be limited, and survival would be enhanced, or because

show abstract

mentioning

confidence: 76%

mentioning

confidence: 99%

See 1 more Smart Citation

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

2014

View full text Add to dashboard Cite

show abstract

“…This can be partially explained by the fact that PIM could have acted as a proxy of most medication classes, including antipsychotics, benzodiazepines, alpha‐adrenergics, NSAIDs and drugs with strong anticholinergic properties (skeletal muscle relaxants, antihistamines, antispasmodics). Drug interactions can cause pharmacokinetic and pharmacodynamic alterations, interfere with cerebral control of micturition (eg, benzodiazepines), interference with sphincter function (eg, alpha‐blocking agents), and disruption of detrusor contractility (eg, anticholinergic medication) …”

Section: Discussionmentioning

confidence: 99%

“…Drug interactions can cause pharmacokinetic and pharmacodynamic alterations, interfere with cerebral control of micturition (eg, benzodiazepines), interference with sphincter function (eg, alpha-blocking agents), and disruption of detrusor contractility (eg, anticholinergic medication). 29 However, limited data are available on possible interactions between PIM and UI on the literature. One study assessed the prevalence of drug interactions in three common geriatric syndromes (delirium, falls, and UI) among older adults living in NHs and home care in Europe.…”

Section: Discussionmentioning

confidence: 99%

Predicting continence decline in institutionalized older people: A longitudinal analysis

Jerez-Roig

Moreira

Câmara

et al. 2019

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people. Methods A 2‐year longitudinal study (with five 6‐month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal‐RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution‐related and health‐related variables were considered to establish the baseline. Time‐dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log‐rank test, and Cox’s regression were applied as statistical methods. Results Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%‐87.3%), 74.7% (CI, 95%: 67.8%‐80.4%), 66.9% (CI, 95%: 59.4%‐73.2%), and 49.3% (CI, 95%: 40.1%‐57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P < 0.001), functional decline (HR = 3.02; P = 0.001) and potentially inappropriate medication (HR = 1.84; P = 0.008). Conclusions The incidence of continence decline and the cumulative probability of maintaining continence status in institutionalized older adults was approximately 39% and 49%, respectively, at the 2‐year follow‐up. Disability and potentially inappropriate drugs at baseline and functional decline across the period predicted continence decline in this cohort.

show abstract

Association of anticholinergic burden with undernutrition in older adults: A cross‐sectional study

2022

View full text Add to dashboard Cite

Background Limited data are available concerning the contribution of drugs with anticholinergic properties (DAPs) to undernutrition among older adults. This study aimed to determine the potential association of anticholinergic burden (ACB) to nutrition status in older people. Methods We prospectively enrolled participants aged over 65 who underwent a comprehensive geriatric assessment between January 2017 and June 2020. Nutrition status was assessed by the Mini Nutritional Assessment–Short Form (MNA‐SF). The ACB was assessed using the ACB scale. Results A total of 615 participants were included in the analysis (mean age ± SD, 78.5 ± 6.6 years; male, 55.3%). The prevalence of undernutrition (MNA‐SF score <12) was 22.6% (n = 139). Participants with undernutrition were predominantly older (P < 0.001), had lower mean body mass index scores (undernutrition, 27.3 ± 5.4 vs healthy, 29.5 ± 8.0; P = 0.007), had a lower educational level (P = 0.016), had higher cardiovascular disease morbidity (P < 0.001), and had a higher ACB (P < 0.001) when compared with those with normal nutrition status. In adjusted analysis, the odds of having undernutrition were higher among participants with an ACB score >1 (odds ratio, 1.20; 95% CI, 1.01–1.43; P = 0.044). The weighted multivariate linear regression analysis showed a significant inverse association between the total ACB score and MNA‐SF score controlling for multiple confounders. Conclusion ACB appears to be inversely correlated with nutrition status among older adults. Undernutrition may be considered an additional reason to consider deprescribing DAPs in this population.

show abstract

How to treat the frail elderly: The challenge of multimorbidity and polypharmacy

Cited by 11 publications

References 13 publications

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

Predicting continence decline in institutionalized older people: A longitudinal analysis

Association of anticholinergic burden with undernutrition in older adults: A cross‐sectional study

Contact Info

Product

Resources

About