Better knowledge on vitamin D and calcium in older people is associated with a higher serum vitamin D level and a higher daily dietary calcium intake

Abstract: Objective: The objective of the present study was to examine knowledge on vitamin D and calcium in a cohort of older adults and to test the association between health knowledge, vitamin D status and dietary calcium intake. Methods: The participants of this cross-sectional survey consisted of 426 individuals (≥65 years), living in residential homes. Participants were tested for their knowledge on vitamin D and calcium using a standardized questionnaire. Serum 25-hydroxyvitamin D3 (25(OH)D3) levels and dietary calcium intake were measured. Results: The mean serum 25(OH)D3 level was 39.1 (±21.4) nmol/l and the mean daily dietary calcium intake was 826 (±242) mg/day. Of the participants, only 3

Can Echocardiographic Findings Predict Falls in Older Persons?

Background. The European and American guidelines state the need for echocardiography in patients with syncope. 50% of older adults with syncope present with a fall. Nonetheless, up to now no data have been published addressing echocardiographic abnormalities in older fallers. Method and Findings. In order to determine the association between echocardiographic abnormalities and falls in older adults, we performed a prospective cohort study, in which 215 new consecutive referrals (age 77.4 SD 6.0) of a geriatric outpatient clinic of a Dutch university hospital were included. During the previous year, 139 had experienced a fall. At baseline, all patients underwent routine two-dimensional and Doppler echocardiography. Falls were recorded during a three-month follow-up. Multivariate adjustment for compounders was performed with a Cox proportional hazards model. 557 patients (26%) fell at least once during follow-up. The adjusted hazard ratio of a fall during follow-up was 135 (95% Cl, 1.08-1.71) for pulmonary hypertension, 1.66 (95% Cl, 1.01 to 2.89) for 4-initial regurgitation, 2.41 (95% Cl, 1.32 to 4.37) for tricuspid regurgitation and 1.76 (95% Cl, 1.03 to 3.01) for pulmonary regurgitation. For aoitic regurgitation the risk of a fall was also increased, but non-significantly. (hazard ratio, 1.57 [95% Cl 0.85 to 2.92]). Trend analysis of the severity of the difterent regurgitations showed a significant relationship for mitral, tricuspid and pulmonary valve regurgitation and pulmonary hypertension. Conclusions. Echo(Dopler)cardiography can be useful in order to identify risk indicators for falling. Presence of pulmonary hypertension or regurgitation of mitral, tricuspid or pulmonary valves was associated with a higher fall risk. Our study indicates that the diagnostic work-up for falls in older adults might be improved by adding an echo(Doppler)cardiogram in selected groups

[Cost]effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study)

Background: Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of fall-risk increasing drugs on the number of new falls versus 'care as usual' in older adults presenting at the Emergency Department after a fall. Methods/Design. A prospective, multi-center, randomized controlled trial will be conducted in hospitals in the Netherlands. Persons aged 65 years who visit the Emergency Department due to a fall are invited to participate in this trial. All patients receive a full geriatric assessment at the research outpatient clinic. Patients are randomized between a structured medication assessment including withdrawal of fall-risk increasing drugs and 'care as usual'. A 3-monthly falls calendar is used for assessing the number of falls, fallers and associated injuries over a one-year follow-up period. Measurements will be at three, six, nine, and twelve months and include functional outcome, healthcare consumption, socio-demographic characteristics, and clinical information. After twelve months a second visit to the research outpatient clinic will be performed, and adherence to the new medication regimen in the intervention group will be measured. The primary outcome will be the incidence of new falls. Secondary outcome measurements are possible health effects of medication withdrawal, health-related quality of life (Short Form-12 and EuroQol-5D), costs, and cost-effectiveness of the intervention. Data will be analyzed using an intention-to-treat analysis. Discussion. The successful completion of this trial will provide evidence on the effectiveness of withdrawal of fall-risk increasing drugs in older patients as a method for falls reduction. Trial Registration. The trial is registered in the Netherlands Trial Register (NTR1593)

The easiest way to predict adverse drug reactions in older persons: reply

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Know-me: a toolkit for designing personalised dementia care

Personalisation is a crucial element in providing person-centred care for people with dementia. This paper presents the development and evaluation of a design toolkit to facilitate the work of designers and healthcare professionals in personalising dementia care. This toolkit, named “Know-me”, was grounded in the findings of Ergonomics in Aging, Co-design, and Data-enabled Design, derived from literature review and from the field during a four-year doctorate project. “Know-me” was designed to be easily accessible, flexible, and engaging, providing concrete and hands-on guidance for designers and healthcare professionals to use in designing for personalised dementia care. A proof-of-concept evaluation of the “Know-me” toolkit was conducted via student projects on design for dementia care. During this process, we found that “Know-me” could be adapted flexibly so that the care team could use some of the tools by themselves. A feature-by-feature comparison of the “Know-me” toolkit with similar state-of-the-art toolkits was conducted, and based upon this, the strengths and weaknesses of the “Know-me” toolkit are discussed. This preliminary study indicates that the “Know-me” toolkit is a helpful addition to the current pool of toolkits on designing for dementia care

New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia

The contribution of specific psychotropic drugs to fall risk in patients with dementia has not been quantified precisely until now. The authors evaluated the dose-response relationship between psychotropic drugs and falls in nursing home residents with dementia. Daily drug use and daily falls were recorded in 248 nursing home residents with dementia from January 1, 2006, to January 1, 2008. For each day of the study period, data on drug use were abstracted from the prescription database, and falls were retrieved from a standardized incident report system, resulting in a data set of 85 074 person-days. The authors found significant dose-response relationships for the use of antipsychotics (hazard ratio [HR], 2.78; 95% confidence interval [CI] 1.49-5.17), anxiolytics (1.60; 1.20-2.14), hypnotics and sedatives (2.58; 1.42-4.68), and antidepressants (2.84; 1.93-4.16). Fall risk increased significantly with 28% at 0.25 of the defined daily dose (DDD) of an antipsychotic or antidepressant, with 8% at 0.2 of the DDD of an anxiolytic, and with 56% at 0.5 of the DDD of a hypnotic or sedative; it increased further with dose increments and with combinations of psych otropics. Even at low dosages, psychotropic drugs are associated with increased fall risk in nursing home residents with dementia

Challenges and risks for older travellers with multimorbidity: focus on pharmacotherapy

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageThe number of older travellers continues to increase internationally. Consequently, physicians are frequently confronted with situations relating to travelling of older people with multiple chronic morbidities and taking multiple medications. The risk of travel-related diseases is more than 2-fold in people with underlying medical conditions in comparison to healthy travellers. Although many guidelines on travelling with a particular chronic disease exist so far, it can be a challenge to tailor these considerations to an individual with multimorbidity. It is important that the health needs and potential vulnerability of the older traveller are recognized by physicians and patients alike. Educating patients on this topic could provide a significant benefit -helping them to enjoy their travel by being well prepared. (C) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved

Onjuist geneesmiddelgebruik bij ouderen opsporen: de herziene STOPP- en START-criteria

- Het gebruik van potentieel ongeschikte geneesmiddelen door ouderen en potentiële omissies in de voorgeschreven geneesmiddelen vormen een omvangrijk probleem. Dit verhoogt het risico op bijwerkingen, maar is deels beïnvloedbaar. - Het gebruik van de in Ierland ontwikkelde STOPP- en START-criteria voor het optimaliseren van farmacotherapie bij ouderen vermindert het aantal geneesmiddelbijwerkingen en medicatiefouten. - Registratie van nieuwe geneesmiddelen, uitbreiding van het aantal potentieel ongeschikte geneesmiddelen en de beschikbaarheid van nieuwe literatuur gaven aanleiding tot herziening van de eerste versie van de STOPP- en START-criteria, die in 2008 verscheen. - Om een breder toepasbaar screeningsinstrument te ontwikkelen werd bij de 2e versie van de STOPP- en START-criteria gekozen voor een consensuspanel met experts op het gebied van farmacotherapie bij ouderen uit 14 Europese landen, waaronder 2 uit Nederland. - De vertaling van de 2e versie van de STOPP- en START-criteria is aangepast aan de Nederlandse situatie, onder meer door geneesmiddelen die in Nederland niet geregistreerd zijn, weg te laten

DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy

This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms “delirogenity” and “delirogenic” to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care