Comprehensive Geriatric Assessment
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December 21, 2023 9:32 AM
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Construct validity of the electronic Veterans Affairs Frailty Index against clinician frailty assessment - DuMontier - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System.

 

Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.

 

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December 3, 7:07 AM
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Association between metabolomics-based biomarker scores and 10-year cognitive decline in men and women. The Doetinchem Cohort Study | Age and Ageing | Oxford Academic

Association between metabolomics-based biomarker scores and 10-year cognitive decline in men and women. The Doetinchem Cohort Study | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

MetaboHealth, not MetaboAge, was associated with cognitive functioning independent of conventional

risk factors. Individual metabolites affect cognitive functioning differently in men and women, suggesting sex-specific

pathophysiological pathways underlying cognitive functioning.

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December 3, 7:03 AM
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Systematic review of guideline recommendations for older and frail adults with type 2 diabetes mellitus | Age and Ageing | Oxford Academic

Systematic review of guideline recommendations for older and frail adults with type 2 diabetes mellitus | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

Most diabetes CPGs recommend strict HbA1c targets in healthier older adults, with more relaxed targets in
those living with frailty or medical complexity. However, significant variability exists in pharmacotherapy recommendations
and there were proportionately less recommendations forindividuals who are frail.

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December 3, 7:01 AM
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Mild behavioural impairment in Parkinson’s disease: a systematic review | Age and Ageing | Oxford Academic

Mild behavioural impairment in Parkinson’s disease: a systematic review | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

This systematic review examines and synthesises findings from relevant studies, enhancing understanding of the symptoms and implications of MBI in PD. Nine studies from five separate research institutions were identified. The conceptualisation of MBI varied considerably, affecting the reported prevalence rates of MBI in individuals with early-stage PD. Among PwP, MBI was associated higher education and impaired cognition. Affective dysregulation and impulse control disorders were primary contributors to MBI; abnormal perception was least contributor. This systematic review underscores the specific characteristics and incidence of MBI in early-stage PD. Mood and impulse control disorders are primary concerns associated with MBI. Future longitudinal studies are required to clarify the progression of these symptoms and evaluate MBI’s potential as an indicator for PD-related dementia or increased dependency.

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December 3, 6:34 AM
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How to get started in medical leadership | The BMJ

How to get started in medical leadership | The BMJ | Comprehensive Geriatric Assessment | Scoop.it
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December 3, 6:24 AM
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Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial

Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial | Comprehensive Geriatric Assessment | Scoop.it

Early DOAC initiation within 4 days after ischaemic stroke associated with atrial fibrillation was non-inferior to delayed initiation for the composite outcome of ischaemic stroke, intracranial haemorrhage, unclassifiable stroke, or systemic embolism at 90 days. Our findings do not support the current common and guideline-supported practice of delaying DOAC initiation after ischaemic stroke with atrial fibrillation.

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December 3, 6:17 AM
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Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly
borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

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December 3, 6:15 AM
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Passive anti-amyloid β immunotherapy in Alzheimer's disease—opportunities and challenges

With the advent of the first disease-modifying, anti-amyloid β-directed passive immunotherapy
for Alzheimer's disease, questions arise who, when, and how to treat. This paper describes
shortly the pathogenic basis of and preclinical data, which have, more than two decades
ago, initiated the development of this vaccination therapy. We discuss clinical trial
results of aducanumab, lecanemab, and donanemab. We also review appropriate use recommendations
of these novel treatments on patient selection and safety monitoring.
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December 3, 6:06 AM
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A New Era in Menopause Management? | Gynecology | JAMA | JAMA Network

A New Era in Menopause Management? | Gynecology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
In contrast to a mere 5 years ago, discussions about menopause are now more mainstream, with the 2024 Super Bowl advertisement for a drug to treat hot flashes and night sweats related to menopause being a recent example. The drug being advertised, fezolinetant, was the first novel dru
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October 16, 2:09 AM
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Are Blood Tests for Alzheimer Disease Ready for Prime Time? | Dementia and Cognitive Impairment | JAMA | JAMA Network

Are Blood Tests for Alzheimer Disease Ready for Prime Time? | Dementia and Cognitive Impairment | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This is a transformative time for patients with Alzheimer disease. Alzheimer disease is increasingly viewed as a treatable condition and managed like other major chronic diseases, such as heart disease and cancer. Management of Alzheimer disease includes early diagnosis with molecula
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October 16, 2:03 AM
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Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care | Neurology | JAMA | JAMA Network

Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care | Neurology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This prospective study evaluates a clinically available Alzheimer disease blood test in primary and secondary care using predefined biomarker cutoff values.
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October 13, 1:58 AM
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Frailty Index Based on Common Laboratory Tests for Patients Starting Home-Based Medical Care - ClinicalKey

Frailty Index Based on Common Laboratory Tests for Patients Starting Home-Based Medical Care - ClinicalKey | Comprehensive Geriatric Assessment | Scoop.it

Objectives: To determine whether a Frailty Index based on laboratory tests (FI-lab) is associated with clinical outcomes independently of a standard nonlaboratory Frailty Index (FI-clinical) in older patients starting home-based medical care.

 

Conclusions and Implications: FI-lab was associated with 2-year mortality in patients starting home-based medical care, independently of FI-clinical, and may be useful for risk assessment in this population. Studies with larger sample sizes are needed.

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October 9, 8:05 AM
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Optimizing Orthogeriatric Hip Fracture Care: Why Fracture Type Matters

This special article emphasizes the complex interplay between specific fracture types, their management options, and the roles of comorbidity and polypharmacy, highlighting the essential role of orthogeriatricians. Orthogeriatricians navigate the complexities posed by comorbidities, frailty, and polypharmacy, significantly influencing treatment outcomes

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October 9, 7:52 AM
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Systematic Review and Meta-Analysis of Diagnostic and Predictive Accuracy of the Clinical Frailty Scale in Older Adults in Emergency Department | Age and Ageing | Oxford Academic

Systematic Review and Meta-Analysis of Diagnostic and Predictive Accuracy of the Clinical Frailty Scale in Older Adults in Emergency Department | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

Background: Older adults attending the Emergency Department (ED) should be assessed using a frailty screening tool as older adults living with frailty are more likely to experience adverse outcomes. The Clinical Frailty Scale (CFS) is commonly used for this. This systematic review and meta-analysis synthesise the literature studying predictive accuracy of the CFS for identifying older adults at risk of adverse outcomes following ED visit, and the diagnostic accuracy of the CFS for identifying older adults living with frailty attending the ED.

 

Conclusion: The CFS successfully identifies those at risk of adverse outcomes of death, ED revisit, hospitalisation and institutionalisation. However, there is a paucity of studies which assess its diagnostic accuracy. Overall, it is a useful screening tool to identify those who may benefit from comprehensive multidisciplinary assessment in the ED

setting.

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December 3, 7:04 AM
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Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment | Age and Ageing | Oxford Academic

Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

This is the first Italian guideline that makes evidence-based recommendations on the diagnosis, treatment and care for people with dementia and mild cognitive impairment and their caregivers.

 

New Thirty-four questions were adopted or adapted from the NICE guideline NG97 and 13 new review questions were added, including 10 on the diagnosis and management of people with mild cognitive impairment.

 

The Italian guideline also included evidence synthesis and recommendations for new disease-modifying drugs.

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December 3, 7:02 AM
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Scoping review of the measurement and analysis of frailty in randomised controlled trials | Age and Ageing | Oxford Academic

Scoping review of the measurement and analysis of frailty in randomised controlled trials | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

Frailty measurement in RCTs is highly variable. Understanding the properties of respective frailty measures and how these relate to frailty as encountered in clinical practice is a priority to ensure that trial findings can inform healthcare delivery for people living with frailty.

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December 3, 6:35 AM
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Association of holidays and the day of the week with suicide risk: multicountry, two stage, time series study | The BMJ

Association of holidays and the day of the week with suicide risk: multicountry, two stage, time series study | The BMJ | Comprehensive Geriatric Assessment | Scoop.it

Suicide risk was highest on Mondays and increased on New Year’s day in most countries. However, the risk of suicide on weekends and Christmas varied by country and territory. The results of this study can help to better understand the short term variations in suicide risks and define suicide prevention action plans and awareness campaigns.

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December 3, 6:31 AM
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Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline | The BMJ

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline | The BMJ | Comprehensive Geriatric Assessment | Scoop.it

benefits and harms of SGLT-2 inhibitor therapy for adults with CKD over a five year period, along with contextual factors, and provided the following recommendations:

1. For adults at low risk of CKD progression and complications, we suggest administering SGLT-2 inhibitors (weak recommendation in favour)

2. For adults at moderate risk of CKD progression and complications, we suggest administering SGLT-2 inhibitors (weak recommendation in favour)

3. For adults at high risk of CKD progression and complications, we recommend administering SGLT-2 inhibitors (strong recommendation in favour)

4. For adults at very high risk of CKD progression and complications, we recommend administering SGLT-2 inhibitors (strong recommendation in favour).

 

Recommendations are applicable to all adults with CKD, irrespective of type 2 diabetes status.

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December 3, 6:22 AM
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Pernkopf was not alone: the Nazi origins of the Spalteholz–Spanner atlas

Pernkopf was not alone: the Nazi origins of the Spalteholz–Spanner atlas | Comprehensive Geriatric Assessment | Scoop.it

Nearly 80 years after the end of the National Socialist (Nazi) regime, its legacies persist with the continued use of anatomical atlases whose precise origins remain unknown.1 Although previous investigations on the history of anatomy during the Nazi
era have revealed unsettling evidence concerning the Pernkopf atlas and other publications of knowledge gained from the bodies of Nazi victims in life and death,2 there remains poor insight into the origins of other anatomical atlases of this period.

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December 3, 6:16 AM
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Japan's lonely deaths: a social epidemic

Japan's lonely deaths: a social epidemic | Comprehensive Geriatric Assessment | Scoop.it

Almost 40 000 people died alone at home in Japan this year—many unnoticed for months—prompting much concern, and new policy. Megan Tatum reports.

 

 

Sergio Ariño Blasco's insight:

El nuevo sindrome geriátrico

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December 3, 6:13 AM
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Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review | Cardiology | JAMA | JAMA Network

Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review | Cardiology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This review summarizes current evidence on recommended treatments for acute pericarditis, its prognosis, and the diagnostic evaluation of individuals with suspected initial or recurrent pericarditis.
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October 16, 2:11 AM
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Community-Acquired Pneumonia: A Review | Infectious Diseases | JAMA | JAMA Network

Community-Acquired Pneumonia: A Review | Infectious Diseases | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This Review summarizes current evidence on pathogenesis, epidemiology, diagnosis, and treatment of community-acquired pneumonia and focuses on adults without immune-compromising conditions.
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October 16, 2:08 AM
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Changes in Alzheimer Disease Blood Biomarkers and Associations With Incident All-Cause Dementia | Dementia and Cognitive Impairment | JAMA | JAMA Network

Changes in Alzheimer Disease Blood Biomarkers and Associations With Incident All-Cause Dementia | Dementia and Cognitive Impairment | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This cohort study characterizes temporal changes in plasma biomarkers, identifies factors associated with changes in plasma biomarkers over time, and evaluates the prospective associations of plasma biomarkers with late-life all-cause dementia.
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October 13, 2:00 AM
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Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales - ClinicalKey

Predictive Validity of Intrinsic Capacity Composite Scores for Risk of Frailty at 2 Years: A Comparison of 4 Scales - ClinicalKey | Comprehensive Geriatric Assessment | Scoop.it

Objective: Intrinsic capacity (IC) and frailty are complementary constructs that encapsulate functional capacities of older adults. Although earlier studies suggest the utility of composite IC scores in predicting risk of frailty, key gaps remain with the lack of direct comparative studies between different IC scales and lack of a composite score based on the World Health Organization Integrated Care for Older People (ICOPE) tool.We aimed to compare different IC scales, including an ICOPE-based scale, in their predictive ability for risk of frailty at 2 years in healthy community-dwelling older adults.

 

Conclusions and Implications: Baseline composite IC score using 2-point per domain scales better predicted risk of frailty at 2 years, predicated on impaired locomotion/vitality and greater number of

impaired domains. For early identification of healthy older adults at risk of frailty, an ICOPE-based scale should be considered, as it is effective and accessible.

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October 9, 8:06 AM
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Brexpiprazole for Agitation Associated With Dementia Due to Alzheimer's Disease

Alzheimer’s disease (AD) is a prevalent neurodegenerative disease characterized by progressive cognitive and functional decline. Nearly all patients with AD develop neuropsychiatric symptoms (NPSs). Agitation is one of the most distressing and challenging NPS. Brexpiprazole is an oral antipsychotic and is the first approved pharmacologic agent in the United States for the treatment of agitation associated with dementia due to AD.

 

Its effect is thought to be from its partial serotonin 5-HT1A and dopamine D2 receptor agonist activity and serotonin 5-HT2A receptor antagonism. Brexpiprazole is a maintenance medication,

and it should not be used “as needed” or as a “PRN” treatment for breakthrough agitation.

 

Brexpiprazole is a major substrate of CYP2D6 and CYP3A4. Dose adjustments may be required for drug interactions or impaired renal or hepatic function. Clinical trials found brexpiprazole 2 to 3 mg/d demonstrated significant improvements in agitation, with brexpiprazole showing an approximate 5-point greater reduction on change in the Cohen-Mansfield Agitation Inventory total score at week 12 from baseline compared with placebo.

 

Brexpiprazole is generally well tolerated and safe, and common adverse reactions when used for this indication include dizziness, headaches, insomnia, nasopharyngitis, somnolence, and urinary tract infections. Like other antipsychotics used for agitation in AD, brexpiprazole is associated with higher mortality rates compared with placebo. In a long-term care setting, there are several considerations for its use. Benefits include an oral agent that is well tolerated and clinical data showing statistically significant effects on agitation. However, brexpiprazole has not been studied in head-to-head clinical trials against other antipsychotics, and there are differing opinions if the agitation score reductions translate to a clinically meaningful difference. The approval of brexpiprazole signals favorably for upcoming agents for this indication, including escitalopram and dextromethorphan-bupropion.

 

Both escitalopram and dextromethorphan-bupropion are currently undergoing clinical trials.

 

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October 9, 7:56 AM
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Facing the Next “Geriatric Giant”—A Systematic Literature Review and Meta-Analysis of Interventions Tackling Loneliness and Social Isolation Among Older Adults

Objectives: Loneliness and social isolation are associated with adverse health outcomes, especially within the older adult population, underlining the need for effective interventions. This systematic review and metaanalysis aims to summarize all available evidence regarding the effectiveness of interventions for loneliness and social isolation, to map out their working mechanisms, and to give implications for policy and practice.

 

Conclusions and Implications: Interventions for loneliness and social isolation can generally be effective, although some unexplained between-study heterogeneity remains. Further research is needed regarding the applicability of interventions across different settings and countries, also considering their cost-effectiveness

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