Journal of the American Geriatrics Society, Год журнала: 2024, Номер unknown
Опубликована: Дек. 10, 2024
The authors report no conflicts of interest. Dr. Mehta is supported by the National Institute on Aging (K01 AG070329). Boyd and analysis were (K24AG056578). Green (R01AG077011). Reeve an NHMRC Investigator Grant (APP1195460). co-authors a chapter multiple chronic conditions for UptoDate. All other interests.
Язык: Английский
Drugs & Aging, Год журнала: 2025, Номер unknown
Опубликована: Янв. 20, 2025
Язык: Английский
Процитировано
0
Aging and Disease, Год журнала: 2025, Номер unknown, С. 0 - 0
Опубликована: Янв. 1, 2025
Recent advances in microbial pathogen research have highlighted the potential of gut microbe-based medicine. One most extensively studied biological pathways is gut-brain axis, which has been shown to reverse neurological disorders. Evidence from animal-based studies dysbiosis suggest complex behavioral changes, such as alterations sociability and anxiety, can be modulated through microbiota. Specifically, mental disorders include major depression, bipolar disorder, schizophrenia. Gastrointestinal diseases reversed by modulating Dementia its related mechanisms are also amenable modulation This review focuses on role microbiota dementia discussing effects depressive symptoms, cognitive function, mood, chronic stress, prospects microbiota-gut-brain axis for dementia. Although animal models revealed promising approaches treating microbiota, it may premature incorporate these interventions into standard clinical practice. The heterogeneity findings trials randomized control yet convincingly demonstrate efficacy reversing complications.
Язык: Английский
Процитировано
0
Journal of the American Geriatrics Society, Год журнала: 2025, Номер unknown
Опубликована: Март 13, 2025
Older adults living with dementia commonly experience polypharmacy and exposure to high-risk medications [1, 2]. According findings from the National Health Aging Trends Study, among people dementia, 1 in 5 believe that they may be taking one or more medicines no longer need, nearly 9 10 are willing stop of their medications, half uncomfortable five [3]. This underscores need for tailored medication optimization strategies, including carefully designed, evidence-based deprescribing interventions. ALIGN (Aligning Medications What Matters Most) was a pragmatic, pharmacist-led telehealth pilot study support primary care providers addressing who were age ≥ 65 prescribed > 7 [4, 5]. The intervention consisted educational brochure, visit by pharmacist patient-care partner dyad discuss patient's context goals preferences, recommendations conveyed provider via electronic health record. goal reduce total burden regimen complexity focusing on what matters most patients partners. With provider's approval, able implement recommended changes. pharmacists held PharmD degrees board certification Geriatric Pharmacy. Pharmacist could include both stopping starting medications; 73% received recommendation medication, dose frequency, while 42% start increase frequency. In this issue Journal American Geriatrics Society, Green colleagues complement reporting an analysis audio-recorded conversations between dyads [5]. By characterizing these conversations, authors aimed provide new insights guide future development qualitative specifically focused how elicitation medication-related priorities partners shaped discussions pharmacists. Importantly, investigator team has described actually happened during visits partners, actual language used explain recommendations. is refreshing step forward beyond usual "sterile" results reported out trials, which rarely ever extend tables figures summarizing mean numbers versus control groups [6], proportion deprescribed targeted class [7, 8]. paper, highlight important role influence have interventions; only four instances declined dyad. addition, highlights realities, practicalities, challenges carrying broad-based interventions directed at complex older complicated regimens polypharmacy. Patients participating average 13 medications. study, there prioritization classes warranted attention. Such decisions left up individual clinical pharmacist. absence strategy target specific high priority (e.g., those considered cognitive impairment [9]) consistent, evidence-based, systematic approach had implications. For example, frequently picked lowest hanging (and least impactful) "fruit" vitamins supplements) deprescribing, preference substantially challenging situations, such as use antipsychotics dementia. As mentioned above, prioritized preferences patients. theory, exactly should happen, but perhaps consideration risks associated particular drug therapy, possible availability nonpharmacologic alternatives. case behavioral symptoms sometimes it seemed if available continue antipsychotic. Yet, considerable evidence supporting nonpharmacological address persons stress [10], strategies fell outside scope intervention. Understandably, felt obligation try do something high-priority symptoms, pain. Sometimes led existing even effectiveness questionable. Examples non-evidence-based included increasing gabapentin back pain, buprenorphine patch treat pain relating neuropathy. There also missed opportunities some inconsistencies regarding recommendations, statin quoted saying partner, "The estimator says about chance heart attack stroke within next years …. That leans me toward it's worth staying cholesterol medicine prevent that." However, another patient, advice opposite: "We're now point where we don't worrying happening 15 now." practicalities spreading scaling deserve mention. time-consuming; over 90% took 20 min, majority, multiple follow-up interactions required. intensity intervention, personnel costs, pose challenge widespread adoption. summary, commended "pulling curtain" investigators acknowledge, "an unexpected finding often continuation potentially inappropriate addition not evidence-based." extraordinarily valuable guiding efforts any good lingering questions lay groundwork research. Among them: (1) Should entire pharmacopeia narrowly limited number high-priority, classes?; (2) right thing when ("what most") conflict safety therapy?; (3) How varied experiences practice styles factor into delivery consistently applied?; (4) solely broadened encompass overall optimization, regimen, appropriate?; (5) empower apply expertise non-pharmacologic further success deprescribing? To paraphrase W. Edwards Deming, "All [deprescribing interventions] perfectly designed get get." shown us just true is. Through bit closer being develop can truly enhance lives Jerry H. Gurwitz prepared manuscript. Dr. serves consultant United Healthcare. publication linked related article et al. view article, https://doi.org/10.1111/jgs.19379.
Язык: Английский
Процитировано
0
Alzheimer s & Dementia Translational Research & Clinical Interventions, Год журнала: 2025, Номер 11(2)
Опубликована: Апрель 1, 2025
Abstract Anti‐amyloid beta monoclonal antibodies (anti‐Aβ mAbs) have received approval from the US Food and Drug Administration for treatment of patients with mild cognitive impairment or dementia due to Alzheimer's disease (collectively known as early AD) based on evidence clinical trials. However, whether findings these trials are generalizable real world is uncertain. We need reliable real‐world safety treatments inform decision making clinicians, patients, caregivers. Using lecanemab an exemplar, we outline key considerations in designing implementing observational study utilization outcomes using established administrative healthcare claims data sources target trial emulation framework. The framework a rigorous causal inference that minimizes common biases studies. approach proposed here can be applied evaluation additional mAbs they become available. Highlights Little about anti‐amyloid disease. Existing support studies their outcomes. Target guide design while minimizing bias. provide analytical future
Язык: Английский
Процитировано
0
Journal of the American Geriatrics Society, Год журнала: 2024, Номер unknown
Опубликована: Дек. 10, 2024
The authors report no conflicts of interest. Dr. Mehta is supported by the National Institute on Aging (K01 AG070329). Boyd and analysis were (K24AG056578). Green (R01AG077011). Reeve an NHMRC Investigator Grant (APP1195460). co-authors a chapter multiple chronic conditions for UptoDate. All other interests.
Язык: Английский
Процитировано
0