The degree of frailty as a translational measure of health in aging

Nature Aging, Год журнала: 2021, Номер 1(8), С. 651 - 665

Опубликована: Авг. 12, 2021

Язык: Английский

---

Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis

BMC Geriatrics, Год журнала: 2022, Номер 22(1)

Опубликована: Июль 19, 2022

Abstract Introduction Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence polypharmacy or factors polypharmacy. We aimed to estimate pooled and in a systematic review meta-analysis. Methods MEDLINE, EMBASE, Cochrane databases were searched for studies restrictions on date. included observational that reported among individuals over age 19. Two reviewers extracted study characteristics including definitions, design, setting, geography, participant demographics. The risk bias was assessed using Newcastle-Ottawa Scales. main outcome prevalence. estimates 95% confidence intervals determined random effects Subgroup analyses undertaken evaluate such as design geography. Meta-regression conducted assess associations between year. Results 106 full-text articles identified. estimated 54 reporting all medication classes 37% (95% CI: 31-43%). Differences different numerical thresholds, publication Sex, geographical location not differences Discussion Our highlights common particularly older adults those inpatient settings. Clinicians should be aware populations who have an increased likelihood experiencing efforts made appropriateness prescribed medications occurrence potentially Conclusions implications undertake minimize inappropriate whenever possible.

Язык: Английский

---

Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication

European Journal of Vascular and Endovascular Surgery, Год журнала: 2023, Номер 67(1), С. 9 - 96

Опубликована: Ноя. 10, 2023

Ankle Brachial Index Bare Metal Stent Coronary Artery Disease Confidence Interval Chronic Limb Threatening Ischaemia Cardiac Rehabilitation Computed Tomography Angiography Cardiovascular Dual Antiplatelet Therapy Drug Coated Balloon Eluting Digital Subtraction expanded PolyTetraFluoroEthylene European Society of Cardiology for Vascular Surgery Guidelines Steering Committee Guideline Writing Home Based Exercise Hazard Ratio Health Related Quality Life Intermittent Claudication International Normalised Major Adverse Events Magnetic Resonance Odds Peripheral Arterial Proprotein Convertase Subtilisin/Kexin type 9 Percutaneous Transluminal Angioplasty Patient Reported Outcome Measure Adjusted Years Randomised Controlled Trial Risk Supervised Toe Pressure The Active detection and Management the Extension atherothrombosis in high coronary patients In comparison with standard Care Atherosclerosis Versus Paclitaxel Setting Primary Stenting Intermediate Length Femoropopliteal Lesions BIOTRONIK’s First Man study Passeo-18 LUX drug releasing PTA Catheter vs. uncoated balloon catheter subjects requiring revascularisation infrapopliteal arteries CANagliflozin cardioVascular Assessment Study Clopidogrel versus vs.Aspirin Patients at Ischaemic AcetylSalicylic acid bypass surgery ARterial disease Cilostazol:A STudy Long-term Effects Comparison Evaluation Biomarkers Claudication:Exercise Vs. Endoluminal Revascularisation Covered Expandable Danish Screening trial Dapagliflozin Prevention outcomes Kidney Heart Failure Reduced Ejection Fraction Outcomes Type 2 Diabetes Dutch Iliac trial:COVERed balloon-expandable vs.uncovered stents common iliac artery Bypass Oral anticoagulants or Aspirin Comparing ELUVIA vs.Bare Treatment Superficial Femoral and/or Proximal Popliteal Empagliflozin, Outcomes, Mortality Empagliflozin a Preserved Ticagrelor Symptomatic Further Research PCSK9 Inhibition Subjects Elevated German Epidemiological on Protection Nord-Trøndelag Survey Self-Expanding vs.Balloon-Expandable Stents Occlusive Invasive not intermittent claudication peripheral arterial interventions mono dual antiplatelet therapy Self-Assessment Method Statin side-effects Or Nocebo Prevalence non-high cardiovascular risk, No overt vascular Diseases nOR diAbetes mellitus Of Progression And PAD Awareness, Risk, Treatment: NEw Resources Survival Alirocumab after Acute Syndrome vs.angioplasty treatment occlusions Endovascular Caused by Obstruction Viborg VIABAHN endoprosthesis vs.bare nitinol stent implantation complex superficial femoral occlusive Viabahn PROPATEN bioactive surface long lesions Rivaroxaban YUKON-drug-eluting Below Knee ZILVER PTX vs.Bypass Zilver randomised paclitaxel-eluting femoropopliteal (ESVS) continuously develops clinical practice guidelines diseases. This is first guideline that specifically covers diagnosis atherosclerotic lower extremity (PAD, see also section 2.1) falling within following stages: (1) asymptomatic limb (Rutherford grade 0/Fontaine stage I); (2) (IC, Rutherford I–III/Fontaine IIa IIb). Thus, management chronic threatening ischaemia (CLTI) falls outside primary purpose this guideline, as such already covered other recent from Society.1Conte M.S. Bradbury A.W. Kolh P. White J.V. Dick F. Fitridge R. et al.Global Limb-Threatening Ischemia.Eur J Vasc Endovasc Surg. 2019; 58: S1-S109Abstract Full Text PDF PubMed Scopus (648) Google Scholar Throughout term refers to both aforementioned patient categories, whereas terms IC are used where certain recommendation only applies particular subcategory. Within context includes infrarenal aorta toes. aim assist clinicians their selection an optimal diagnostic therapeutic pathway during centred shared decision making. A secondary contribute aligned research process across countries globally. Both landscapes have evolved markedly space years introduction new modalities, imaging protocols, options. These include increased understanding utilisation non-interventional options exercise preventive pharmacotherapy continuous advancements endovascular becoming available increasing number patients. scope provide comprehensive, evidence based clear recommendations many possible different steps decisions fall process. all encompassing, including people sex identities, general, these apply adults over age 18 years. clinician responsible patient’s care will differ country, among others surgeons, angiologists, cardiologists, interventional radiologists, physicians, rehabilitation specialists. were therefore developed multidisciplinary group specialists field (see Appendix B) promote highest quality available. should be considered legal care. document provides guidance support, choice ultimately depend individual setting responsibility treating physician. All ESVS guidelines, app smartphone tablet versions, can downloaded free charge website (https://www.esvs.org/journal/guidelines/). AGREE reporting standards throughout II checklist included supplementary material (Appendix A).2Brouwers M.C. Kerkvliet K. Spithoff Next Steps ConsortiumThe Reporting Checklist: tool improve guidelines.BMJ. 2016; 352: i1152Crossref (436) development followed principal suggested cycle, was further informed Clinical Practice Development Scheme.3Antoniou G.A. Bastos Goncalves Bjorck M. Chakfe N. Coscas Dias N.V. al.Editor's Choice - Scheme: An Overview Evidence Methods, Decision Frameworks, Standards Development.Eur 2022; 63: 791-799Abstract (0) Members (GWC) selected chairs collaboration (GSC) represent expert deeply involved PAD. representation disciplines surgery, angiology, physiotherapy, medicine A). GWC provided annual disclosure statements regarding relationships which might perceived conflicts interest. headquarters upon request ([email protected]). received no financial support any pharmaceutical, medical device, industry body develop guidelines. Videoconference software along travel accommodation costs mandatory meetings funded ESVS. GSC undertaking review several independent external experts organisation. final version checked approved members GSC. Following completion second draft 15 January 2022, sent out Swedish Lung Association (https://www.hjart-lung.se/om-oss/about-us/); non-profit national organisation formed 1939 strives life persons lung diseases works ensure heart, vascular, receive they need. invited comments public perspectives full content. After reading through response stated that, does medically trained personnel, neither elected representatives nor civil servants, could comment specific content They, however, welcomed work done design compilation knowledge, propose best treatment, science experience. Overall, positive opinion held introductory meeting 23 24 June 2021 video conference, list topics author assignments determined consensual agreement. met monthly videoconference discuss writing ongoing issues. completed internally reviewed, again 21 22 April 2022 approve wording each recommendation. If disagreed meeting, open vote (where participated had same voting rights) simple majority decisive acceptance Detailed search strategies topic sections Supplementary material. performed literature searches Medline/PubMed, Embase, Cochrane Library inception up date specified peer reviewed publications. Hand searching references performed. As per systematic last updated November when worked revision draft. July 2023. Selection studies inclusion titles abstracts retrieved studies. pyramid meta-analysis trials top, trials, observational studies, finally Case reports, abstracts, vitro excluded leaving base pyramid. Other documents if applied approach produced own meta-analyses existing literature. For 3.3 suitable consensus available, extensive DELPHI use reported outcome measures arranged published separately part guideline.4Arndt H. Nordanstig J. Bertges D.J. Budtz-Lilly Venermo Espada C.L. al.A Delphi Consensus registries claudication: standard.Eur 64: 526-533Abstract (7) 6.4 there appropriate GWC.5Koeckerling D. Raguindin P.F. Kastrati L. Bernhard S. Barker Quiroga Centeno A.C. al.Endovascular revascularization aortoiliac disease: meta-analysis.Eur 2023; 44: 935-950Google underpin shown directly table, details given more comprehensive tables (ESC) system grading level accompanying class recommendation, graded C (Table 1) being highest. strength (class) I III strongest 2). subcategory subcategorised into IIb overall assessment robustness alongside concurrent experience GWC.Table 1Levels adapted system.Level AData derived multiple trialsLevel BData single large non-randomised studiesLevel CConsensus small retrospective Open table tab Table 2Class system.ClassDefinitionWordingIEvidence general agreement procedure beneficial, useful, effectiveis recommendedIIaConflicting divergence about usefulness efficacy procedure: weight favour efficacyshould consideredIIbConflicting less well established opinionmay consideredIIIEvidence useful effective some cases may harmfulis recommended, focusing IC. However, ESC/ESVS 2017 Diagnosis relevant potentially overlap guideline.6Aboyans V. Ricco J.B. Bartelink M.E.L. Brodmann Cohnert T. ESC Diseases, (ESVS).Eur 2018; 55: 305-368Abstract (608) Furthermore, cover acute presentations, 2020 Ischaemia.7Bjorck Earnshaw J.J. Acosta Cochennec Debus E.S. Ischaemia.Eur 2020; 59: 173-218Abstract (214) 2023 Antithrombotic contains antithrombotic therapies patients, far possible; account potential emerged publication guideline. When changes updates previous it discussed section, changed briefly summarised below 3).Table 3Brief overview differences between guideline.GuidelineYear printed publicationRecommendation guidelinesESVS recommendationReasons differencesCanadian Disease2022We suggest against routine testing inferring global without symptoms PAD, who clinically symptomatic atherosclerosis another territory (Weak Recommendation;Moderate evidence).Recommendation 4:For individuals risk disease, focused screening ankle brachial index measurements lowest recorded pressure considered, prevention strategies. (IIb, B)They manifested territories than legs (and thus having risk).European Medicine (ESVM) Disease2019It recommended diabetes screened (Class Level B)Recommendation recommend broader population 3.1.1.2).2017 (ESVS)2018In (LEAD) ABI measurement stratification. B)Screening LEAD heart failure. C)Recommendation manifest failure suggests (ESVS)2018Measurement indicated line non-invasive test (LEAD). 1 5:The establish disease.(I, B)Current supports upgrading B, two one review, meta-analysis, 3.1.3.1)Society extremities: claudication2015Recommendation 2.1We using signs suggestive disease. borderline normal (> 0.9) suggestive, we ABI. (Grade A)Recommendation downgrading B. 3.1.3.1)European Disease2019Measurement Doppler occlusion verify values ≤ 0.9 significant 6:It cutoff value diagnosis, ≥ 1.4 inconclusive.(I, C)A has been added incompressible (ABI 1.4) led C. B ESVM guideline.European score calculation 7:When estimate severity follow revascularisation, calculated dividing systolic arm pressure. (I, B)The upgraded review. statement scientific American Association. (Aboyans al. Circulation 2012) turn Grade recommendation.Canadian smoking cessation ranging intensive counselling, nicotine replacement therapy, bupropion, varenicline, sometimes e-cigarettes (Strong Recommendation; High Evidence).Recommendation 22:For smoke, councelling intervention recommended. 23:For periperal either alone combination pharmacological due its higher effectiveness compared alternatives. B)We current differently, especially bupropion. We harm chapter 4.1.1.1)Canadian Disease2022Statin add (ezetimibe PCSK-9 inhibitors) receiving maximally tolerated dose statin low density lipoprotein cholesterol 1.8 mmol/L, 2.4 mmol/L apolipoprotein 100 0.7 mg/dL.Recommendation 32:For reduce concentrations < (< 55 mg/dL) decrease 50% baseline 55–110 mg/dL. slightly threshold, although recognise threshold mainly heterogeneous cohorts driven data inhibitors.2021 practice2021Considered risk:Documented (ASCVD), unequivocal imaging. Documented ASCVD AMI, ACS, procedures, stroke TIA, aortic aneurysm PAD.Symptomatic 0.90) associated doubling 10 year rate events, CV mortality, total mortality.Recommendation 44For even asymptomatic, consider enhancing factor event cause mortality. A)The classifies documented ASCVD, emphasises PAD.In our method recognition events beds, always very events. A)andIt 44:For quoted together similar message 43 guideline.Society 5.5We selective BMS aorto-iliac angioplasty both, improved technical success patency. 55:For disabling undergoing bare metal stenting distal embolisation. embolisation performing why did occlusions. results recently DISCOVER show benefit uncovered 6.4).Society 5.6We AIOD presence severe calcification aneurysmal rupture unprotected dilation. 57:For Trans-Atlantic Inter-Society Document C/D lesions, placement patency rates. B)Our precisely targets (i.e., TASC D) vessel substantially higher.

Язык: Английский

---

Polypharmacy stewardship: a novel approach to tackle a major public health crisis

The Lancet Healthy Longevity, Год журнала: 2023, Номер 4(5), С. e228 - e235

Опубликована: Апрель 5, 2023

With growing global concern regarding medication-related harm, WHO launched a patient safety challenge, Medication Without Harm, in March, 2017. Multimorbidity, polypharmacy, and fragmented health care (ie, patients attending appointments with multiple physicians various health-care settings) are key drivers of which can result negative functional outcomes, high rates hospitalisation, excess morbidity mortality, particularly frailty older than 75 years. Some studies have examined the effect medication stewardship interventions cohorts, but focused on narrow spectrum potentially adverse practices, mixed results. In response to we propose novel concept broad-spectrum polypharmacy stewardship, coordinated intervention designed improve management multimorbidities, taking into account inappropriate medications, potential prescribing omissions, drug-drug drug-disease interactions, cascades, aligning treatment regimens condition, prognosis, preferences individual patient. Although efficacy need be tested well clinical trials, that this approach could minimise harm people multimorbidities exposed polypharmacy.

Язык: Английский

---

Prevalence and trends of polypharmacy in U.S. adults, 1999–2018

Global Health Research and Policy, Год журнала: 2023, Номер 8(1)

Опубликована: Июль 12, 2023

Abstract Background Polypharmacy is one of the most important health issues for its potential impacts on disease burden and healthcare costs. The aim this study was to update a comprehensive picture prevalence trends in polypharmacy over 20 years U.S. adults. Methods Participants included 55,081 adults aged ≥ from National Health Nutrition Examination Survey, January 1, 1999, through December 31, 2018. simultaneously use 5 drugs individual defined as polypharmacy. were evaluated among within different demo-socioeconomic status pre-existing diseases. Results From 1999–2000 2017–2018, overall percentages with remained rise, increasing 8.2% (7.2–9.2%) 17.1% (15.7–18.5%) (average annual percentage change [AAPC] = 2.9%, P .001). considerably higher elderly (from 23.5% 44.1%), heart 40.6% 61.7%), diabetes 36.3% 57.7%). Also, we observed greater increase rate men (AAPC 4.1%, < .001), Mexican American 6.3%, non-Hispanic Black 4.4%, Conclusions continually especially older, patients disease, or diabetes. high urges providers policymakers manage specific population groups.

Язык: Английский

---

Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review

The Lancet Healthy Longevity, Год журнала: 2024, Номер 5(4), С. e287 - e296

Опубликована: Март 4, 2024

Multimorbidity (multiple conditions) and polypharmacy medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined multimorbidity among adults (≥18 years) older (≥65 in clinical community settings. Six electronic databases were searched, 87 studies retained after two levels screening. Most focused on 65 years done population-based Although operational definitions varied across studies, consistent cut-points (two or more conditions five used most studies. adult samples, ranged from 4·8% 93·1%, while 2·6% 86·6%. High heterogeneity between indicates for reporting specific lists medications definitions.

Язык: Английский

---

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

The journal of nutrition health & aging, Год журнала: 2025, Номер 29(1), С. 100401 - 100401

Опубликована: Янв. 1, 2025

Aging, a universal and inevitable process, is characterized by progressive accumulation of physiological alterations functional decline over time, leading to increased vulnerability diseases ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) exercise, significantly modulate aging phenotypes. Physical exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance function, reduce the burden non-communicable chronic including cardiometabolic disease, cancer, musculoskeletal neurological conditions, respiratory well premature mortality. influences cellular molecular drivers biological aging, slowing rates-a foundational aspect geroscience. Thus, PA serves both preventive medicine therapeutic agent in pathological states. Sub-optimal levels correlate with disease prevalence populations. Structured prescriptions should therefore be customized monitored like any other medical treatment, considering dose-response relationships specific adaptations necessary for intended outcomes. Current guidelines recommend multifaceted regimen that includes aerobic, resistance, balance, flexibility training through structured incidental (integrated lifestyle) activities. Tailored programs have proven effective helping older adults maintain their capacities, extending enhancing quality life. Particularly important are anabolic exercises, such Progressive resistance (PRT), which indispensable maintaining improving capacity adults, particularly those frailty, sarcopenia osteoporosis, hospitalized residential aged care. Multicomponent interventions include cognitive tasks hallmarks frailty (low body mass, strength, mobility, level, energy) thus preventing falls optimizing during aging. Importantly, PA/exercise displays characteristics varies between individuals, necessitating personalized modalities tailored conditions. Precision remains significant area further research, given global impact broad effects PA. Economic analyses underscore cost benefits programs, justifying broader integration into care adults. However, despite these benefits, far from fully integrated practice people. Many healthcare professionals, geriatricians, need more incorporate directly patient care, whether settings hospitals, outpatient clinics, Education about use isolated adjunctive treatment geriatric syndromes would do much ease problems polypharmacy widespread prescription potentially inappropriate medications. This intersection prescriptive practices offers promising approach well-being An strategy combines pharmacotherapy optimize vitality independence people whilst minimizing adverse drug reactions. consensus provides rationale promotion, prevention, management strategies Guidelines included dosages efficacy randomized controlled trials. Descriptions beneficial changes, attenuation phenotypes, role disability provided. The sarcopenia, neuropsychological emphasized. Recommendations bridge existing knowledge implementation gaps integrate mainstream Particular attention paid it applies geroscience, inter-individual variability adaptation demonstrated adult cohorts. Overall, this foundation applying current base an population span

Язык: Английский

---

Consumer Attitudes Towards Deprescribing: A Systematic Review and Meta-Analysis

The Journals of Gerontology Series A, Год журнала: 2021, Номер 77(5), С. 1020 - 1034

Опубликована: Авг. 14, 2021

Abstract Background Harmful and/or unnecessary medication use in older adults is common. This indicates deprescribing (supervised withdrawal of inappropriate medicines) not happening as often it should. study aimed to synthesize the results Patients’ Attitudes Towards Deprescribing (PATD) questionnaire (and revised versions). Methods Databases were searched from January 2013 March 2020. Google Scholar was used for citation searching development and validation manuscripts identify original research using validated PATD, PATD (older adult caregiver versions), version people with cognitive impairment (rPATDcog). Two authors extracted data independently. A meta-analysis proportions (random-effects model) conducted subgroup meta-analyses setting population. The primary outcome question: “If my doctor said possible, I would be willing stop one or more medicines.” Secondary outcomes associations between participant characteristics other (r)PATD results. Results We included 46 articles describing 40 studies (n = 10,816 participants). found proportion participants who agreed strongly this statement 84% (95% CI 81%–88%) 80% 74%–86%) patients caregivers, respectively, significant heterogeneity (I2 95% 77%). Conclusion Consumers reported willingness have a deprescribed although should interpreted caution due heterogeneity. findings moves toward understanding attitudes deprescribing, which could increase discussion uptake recommendations clinical practice.

Язык: Английский

---

Polypharmacy in elderly people

Wiener Medizinische Wochenschrift, Год журнала: 2022, Номер 172(5-6), С. 109 - 113

Опубликована: Янв. 10, 2022

Язык: Английский

---

Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians

JAMA Internal Medicine, Год журнала: 2022, Номер 182(5), С. 534 - 534

Опубликована: Март 28, 2022

Individuals with dementia or mild cognitive impairment frequently have multiple chronic conditions (defined as ≥2 medical conditions) and take medications, increasing their risk for adverse outcomes. Deprescribing (reducing stopping medications which potential harms outweigh benefits) may decrease of

Язык: Английский

---