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

Factors influencing ICU referral at the end of life in the elderly

Referral to the intensive care unit (ICU) and frequency of do-not-resuscitate (DNR) decisions at the end of life (EOL) in adult hospitalized patients a parts per thousand yen75 years and those < 75 years were examined and influencing factors in the elderly were determined. Data were prospectively collected in all adult patients who deceased during a 12-week period in 2007 and a 16-week period in 2008 at a university hospital in Belgium. Overall, 330 adult patients died of whom 33% were a parts per thousand yen75 years old. Patients a parts per thousand yen75 years old were less often referred to ICU at the EOL (42% vs. 58%, p=0.008) and less frequently died in the ICU (31% vs. 46%, p=0.012) as compared to patients < 75 years old. However, there was no difference in frequency of DNR decisions (87% vs. 88%, p=0.937) for patients dying on non-ICU wards. After adjusting for age, gender, and the Charlson comorbidity index, being admitted on a geriatric ward (OR 0.30, 95% CI 0.10-0.85, p=0.024) and having an active malignant disease (OR 0.39, 95% CI 0.19-0.78, p=0.008) were the only factors associated with a lower risk of dying in the ICU. Patients a parts per thousand yen75 years are less often referred to the ICU at the EOL as compared to patients < 75 years old. However, the risk of dying in the ICU was only lower for elderly with cancer and for those admitted to the geriatric ward

A Parametric Bootstrap Version of Hedges’ Homogeneity Test

Hedges’ Q-test is frequently used in meta-analyses to evaluate the homogeneity of effect sizes, but for several kinds of effect size measures it does not always appropriately control the Type 1 error probability. Therefore we propose a parametric bootstrap version, which shows Type 1 error control under a broad set of circumstances. This is confirmed in a small simulation study

Symptom assessment and management at the end of life

As people age, the number and complexity of illnesses they develop increases. Symptoms during the last year of life in older persons are often a combination of the underlying life-threatening illness and other chronic conditions. These may be complicated by psychosocial and spiritual needs, related to life events such as bereavement. Geriatric palliative medicine involves the care and management of older patients’ progressive advanced disease, for whom the aim is quality of life. It focuses on detailed geriatric assessment, relief from pain and other symptoms such as anorexia, constipation, or delirium, and also management of psychological problems including depression or anxiety. This may be more challenging in people with cognitive impairment who may not be able to express whether they are in pain or otherwise suffering. Adequate pain and symptom management at the end of life emphasizes the need for a tailored multidisciplinary approach for patients and their family

Pain assessment and management in cognitively intact and impaired patients

Pain is common in older people, affecting up to 60% of older community-dwelling older persons with and without dementia. Chronic pain has a significant impact on the quality of life of older people. Since pain is often underrecognized in the older population, systematic screening and assessment with appropriate tools for the target population, is recommended. A holistic, multidisciplinary approach may offer meaningful support. There are no neurophysiological arguments that pain perception and tolerance are affected by the ageing process. Dementia does not change the sensory perception of pain but can cause changes in the meaning and recognition of the sensation. It is possible to safely use non-pharmacological treatments and available analgesics, provided the clinician has a good knowledge of the side effects of the treatments. In patients with advanced dementia and patients at the end of life, alternative routes of administration of analgesics should be considered.</p

The Children’s Loneliness Scale : factor structure and construct validity in Belgian children

The present study examined the factor structure and construct validity of the Children's Loneliness Scale (CLS), a popular measure of childhood loneliness, in Belgian children. Analyses were conducted on two samples of fifth and sixth graders in Belgium, for a total of 1,069 children. A single-factor structure proved superior to alternative solutions proposed in the literature, when taking item wording into account. Construct validity was shown by substantial associations with related constructs, based on both self-reported (e.g., depressive symptoms and low social self-esteem), and peer-reported variables (e.g., victimization). Furthermore, a significant association was found between the CLS and a peer-reported measure of loneliness. Collectively, these findings provide a solid foundation for the continuing use of the CLS as a measure of childhood loneliness

Factors associated with the goal of treatment in the last week of life in old compared to very old patients: a population-based death certificate survey

Background: Little is known about the type of care older people of different ages receive at the end of life. The goal of treatment is an important parameter of the quality of end-of-life care. This study aims to provide an evaluation of the main goal of treatment in the last week of life of people aged 86 and older compared with those between 75 and 85 and to examine how treatment goals are associated with age. Methods: Population-based cross sectional survey in Flanders, Belgium. A stratified random sample of death certificates was drawn of people who died between 1 June and 30 November 2007. The effective study sample included 3,623 deaths (response rate: 58.4%). Non-sudden deaths of patients aged 75 years and older were selected (N = 1681). Main outcome was the main goal of treatment in the last week of life (palliative care or life-prolonging/curative treatment). Results: In patients older than 75, the main goal of treatment in the last week was in the majority of cases palliative care (77.9%). Patients between 75 and 85 more often received life-prolonging/curative treatment than older patients (26.6% vs. 15.8%). Most patient and health care characteristics are similarly related to the main goal of treatment in both age groups. The patient's age was independently related to having comfort care as the main goal of treatment. The main goal of treatment was also independently associated with the patient's sex, cause and place of death and the time already in treatment. Conclusion: Age is independently related to the main goal of treatment in the last week of life with people over 85 being more likely to receive palliative care and less likely to receive curative/life-prolonging treatment compared with those aged 75-85. This difference could be due to the patient's wishes but could also be the result of the attitudes of care givers towards the treatment of older people