Cyclosporine treatment of acquired hemophilia due to factor VIII antibodies

Acquired hemophilia, caused by autoantibodies against coagulation factor VIII, is usually treated with steroids, cyclophosphamide, intravenous gammaglobulins and sporadically other drugs. We describe the case of a patient in whom the common therapeutic choice was unsuccessful, but cyclosporine proved to be effective

Adverse drug reactions in older people : detection and prevention

Adverse drug reactions (ADRs) in older adults are an important healthcare problem since they are frequently a cause of hospitalization, occur commonly during admission, and are an important cause of morbidity and mortality. Older adults are particularly susceptible to ADRs because they are usually on multiple drug regimens and because age is associated with changes in pharmacokinetics and pharmacodynamics. The presentation of an ADR in older adults is often atypical, which further complicates its recognition. One potential strategy for improving recognition of ADRs is to identify those patients who are at risk of an ADR. The recently developed GerontoNet ADR Risk Score is a practical tool for identification of older patients who are at increased risk for an ADR and who may represent a target for interventions aimed at reducing ADRs. Provision of adequate education in the domain of clinical geriatric pharmacology can improve recognition of ADRs. Besides formal surveillance systems, built-in computer programs with electronic prescribing databases and clinical pharmacist involvement in patient care within multidisciplinary geriatric teams might help to minimize the occurrence of ADRs. In addition, a number of actions can be taken in hospitals to stimulate appropriate prescribing and to assure adequate communication between primary and hospital care. In older adults with complex medical problems and needs, a global evaluation obtained through a comprehensive geriatric assessment may be helpful in simplifying drug prescription and prioritizing pharmacological and healthcare needs, resulting in an improvement in quality of prescribing

Statins for primary and secondary prevention in the oldest old : an overview of the existing evidence

Hypercholesterolemia, although a modifiable risk factor for cardiovascular disease, is still one of the leading causes of death among older people in western countries. The use of statins among cholesterol reducing agents in both primary and secondary prevention has not been extensively studied in older patients in contrast to middle-aged patients. Despite a growing body of evidence in secondary prevention, statins are still under utilized in older patients with established vascular disease. On the other hand, the benefits of statins in primary prevention are not so clear. Therefore, the systematic use of statins in older patients with hypercholesterolemia needs to be further investigated

Multimorbidity : definition, assessment, measurement and impact

Research and clinical practice mostly focus on single-disease approaches whereas in reality many patients suffer from more than one chronic condition. The co-occurrence of conditions has increasingly been defined as multimorbidity. Multimorbidity challenges patients, providers and health systems. This has increased the interest of researchers, clinicians and policy makers. However, multimorbidity poses important challenges to those who want to study it. This chapter provides an overview on the definition and measurement of multimorbidity from an epidemiological approach and elicits possible effective approaches to overcome the important clinical challenges of care for this growing group of patients. The aging of the population, due to two demographic effects, namely increasing longevity and declining fertility, is a widespread phenomenon across the world. At the same time, it is an enormous challenge as aging populations obviously results in more people with chronic diseases. Research and clinical practice have mainly focused on building evidence for single diseases while in reality 50% of patients with a chronic disease have more than one medical condition. Besides, the complexity of health problems increases dramatically: 20%–40% of patients aged 65 or older suffer from more than 5 chronic diseases. The complexity of multimorbidity challenges research processes on care for multimorbidity)

Late-life depression : issues for the general practitioner

Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD

Longitudinal analysis of the relationship between physical function and mortality in ambulatory older men

Background. Low physical performance is an important characteristic of frailty and sarcopenia. In this study, we wanted to assess and compare the predictive value of physical function measurements for all-cause mortality in older men. Methods. Data are from a longitudinal study of a population-based sample of 352 ambulatory older men aged 71 to 86 at study baseline. The Rapid disability rating scale-2, 36-Item short form health survey, Hand grip strength, Five times sit-to-stand test, Standing balance, and Timed Up and Go test were determined at baseline. Associations with all-cause mortality were assessed using Cox proportional hazard analyses. Age, BMI, smoking status, education, physical activity, and cognitive status were included as confounders. Follow-up exceeded 15 years. Results. The mean age of participants was 76 ± 4.2 years. Average follow-up duration was 184 ± 2 months. Seventy-eight percent (273) of the 352 men died during follow-up, with a median survival time of 110 months. All examined physical function measurements were associated with all-cause mortality. The Timed Up and Go test was the best predictor (adjusted HR per SD increase = 1.58, 95% CI = 1.40-1.79, P < 0.001) for global mortality. Conclusions. Our findings demonstrate that physical function measurements are important in the evaluation of older persons. We encourage the use of the Timed Up and Go test as a reliable, quick and feasible screening tool in clinical settings

S. Jackson, P. Jansen, A. Mangoni (red.). Prescribing for Elderly Patients

bespreking boek S. Jackson, P. Jansen, A. Mangoni (red.). Prescribing for Elderly Patients.-523 blz. Wiley-Blackwell, Chichester, 2009, ISBN 978-0-470- 02428-