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Scooped by
Sergio Ariño Blasco
October 16, 2:11 AM
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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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Scooped by
Sergio Ariño Blasco
October 16, 2:08 AM
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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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Scooped by
Sergio Ariño Blasco
October 13, 2:00 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 8:06 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 7:56 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 7:48 AM
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Abstract. The UK is launching a new free vaccination programme against respiratory syncytial virus (RSV) in adults aged 75 or over. This follows the develo
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Scooped by
Sergio Ariño Blasco
October 9, 7:25 AM
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PAH deficiency, although a rare inborn disorder of metabolism, is among the most common disorders detected through newborn screening, with a global prevalence of approximately 1:24 000 livebirths1 and an estimated half a million individuals affected worldwide. PAH deficiency is also colloquially known as phenylketonuria because of its association with urinary phenylpyruvate excretion, a detectable phenotype that was used clinically for diagnosis before the advent of amino acid analysis and measurement of blood L-Phe.
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Scooped by
Sergio Ariño Blasco
July 1, 7:34 AM
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In this longitudinal cohort study of participants who were predominantly aged 70 years and above, without a prior CVD event or major cognitive impairments, ASCVDRS and SCORE2-OP were associated with an increased risk of dementia and cognitive decline among both men and women. The FRS, however, was not associated with the risk of dementia, but was associated with an increased risk of cognitive decline for women only. Our study demonstrated clear differences in the associations depending on the risk score examined and, in particular, a lack of evidence that FRS was associated with risk of dementia
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Scooped by
Sergio Ariño Blasco
July 1, 7:19 AM
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This prospective study of 248 patients ≥65 years with cancer in need for surgery shows that out one of six patients developed postoperative cognitive dysfunction (POCD) 3 months after surgery. Age >75, preoperative Mini-Mental State Examination (MMSE) score ≤26 and major surgery were independent significant predictors for POCD. No significant relations were found between the early inflammatory response for the markers C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL-10, and Neutrophil gelatinase-associated lipocalin (NGAL) and the development of POCD. This study contributes in unraveling the complex and multifactorial etiology of the development of POCD.
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Scooped by
Sergio Ariño Blasco
June 23, 11:21 AM
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Modern hygiene has been described as the reaction against the old fatalistic creed that deaths inevitably occur at a constant rate. The study of vital statistics shows that there is no “iron law of mortality.” According to a report1 prepared for the National Conservation Commission fiftee
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Scooped by
Sergio Ariño Blasco
April 25, 3:44 AM
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Background: Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited. Objective: To evaluate long-term health outcomes among postmenopausal women in the Women’s Health Initiative CaD trial. Design: Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611) Setting: A multicenter (n = 40) trial across the United States. Participants: 36 282 postmenopausal women with no history of breast or colorectal cancer. Intervention: Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo. Measurements: Incidence of colorectal, invasive breast, and total cancer; disease-specific and all-cause mortality; total cardiovascular disease (CVD); and hip fracture by randomization assignment (through December 2020). Analyses were stratified on personal supplement use. Results: For women randomly assigned to CaD versus placebo, a 7% reduction in cancer mortality was observed after a median cumulative follow-up of 22.3 years (1817 vs. 1943 deaths; hazard ratio [HR], 0.93 [95% CI, 0.87 to 0.99]), along with a 6% increase in CVD mortality (2621 vs. 2420 deaths; HR, 1.06 [CI, 1.01 to 1.12]). There was no overall effect on other measures, including all-cause mortality (7834 vs. 7748 deaths; HR, 1.00 [CI, 0.97 to 1.03]). Estimates for cancer incidence varied widely when stratified by whether participants reported supplement use before randomization, whereas estimates on mortality did not vary, except for CVD mortality. Limitation: Hip fracture and CVD outcomes were available on only a subset of participants, and effects of calcium versus vitamin D versus joint supplementation could not be disentangled. Conclusion: Calcium and vitamin D supplements seemed to reduce cancer mortality and increase CVD mortality after more than 20 years of follow-up among postmenopausal women, with no effect on all-cause mortality. Primary Funding Source: National Heart, Lung, and Blood Institute of the National Institutes of Health.
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Scooped by
Sergio Ariño Blasco
April 25, 3:03 AM
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People who were infected with SARS-CoV-2 tended to score slightly worse on cognitive assessments—particularly in memory, reasoning, and tasks that require executive function—than those who were not infected, according to data from about 113 000 participants in England. The score was th
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Scooped by
Sergio Ariño Blasco
April 10, 2:25 AM
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Scooped by
Sergio Ariño Blasco
October 16, 2:09 AM
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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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Scooped by
Sergio Ariño Blasco
October 16, 2:03 AM
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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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Scooped by
Sergio Ariño Blasco
October 13, 1:58 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 8:05 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 7:52 AM
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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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Scooped by
Sergio Ariño Blasco
October 9, 7:46 AM
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Abstract. The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to
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Scooped by
Sergio Ariño Blasco
July 1, 8:36 AM
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If time or other resources do not permit the full implementation of GRADE, the following recommendations can be considered: (1) limit rating COE to the main intervention and comparator and limit the number of outcomes to critical benefits and harms; (2) if a literature review or a Delphi approach to rate the importance of outcomes is not feasible, rely on informal judgements of knowledge users, topic experts or team members; (3) replace independent rating of the COE by two reviewers with single-reviewer rating and verification by a second reviewer and (4) if effect estimates of a well-conducted systematic review are incorporated into an RR, use existing COE grades from such a review. We advise against changing the definition of COE or the domains considered part of the GRADE approach for RRs.
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Scooped by
Sergio Ariño Blasco
July 1, 7:22 AM
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This study developed and internally validated a screening tool using diverse data sources to predict adverse outcomes in older adults 6 months post-ED visit. The model's accuracy was moderate, and compared to existing tools performs favorably, surpassing two commonly cited ED screening tools: ISAR and TRST.
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Scooped by
Sergio Ariño Blasco
July 1, 3:50 AM
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The exigencies of managing acutely ill residents within nursing homes have led to an increase in ambulance conveyances to the emergency department. This is further compounded by a shortage of adequately trained nursing staff and on-site physicians available around the clock. An acute regional hospital, strategically located in the epicenter of nursing home facilities in Singapore, encountered this challenge on its inception in 2018 within the northeast region. In response, the institution initiated a collaboration, EAGLEcareACT (Enhancing Advance Care Planning, Geriatrics, and End-of-Life Care Acute Care Team), aimed at rectifying the prevailing care disparities between neighboring nursing homes and the hospital.
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Scooped by
Sergio Ariño Blasco
May 25, 3:44 AM
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Scooped by
Sergio Ariño Blasco
April 25, 3:26 AM
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Scooped by
Sergio Ariño Blasco
April 10, 2:45 AM
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In their article, Ganguli and colleagues characterized a new measure of health care utilization—“health care contact days.” The editorialists find the measure a promising new way to understand ho
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