Advantages and disadvantages of direct oral anticoagulants in older patients

Atrial fibrillation (AF) and venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, are conditions that increase with age. Anticoagulant therapy is strongly recommended both in patients with AF for the prevention of cardioembolic stroke, and for treatment of VTE and prevention of recurrent VTE. Until recently, vitamin K antagonists (VKAs) were the only oral drugs for long-term anticoagulation. In the past decade, four direct oral anticoagulants (DOACs) were approved: a direct thrombin inhibitor (dabigatran) and three factor Xa inhibitors (apixaban, rivaroxaban, edoxaban). Despite increasing evidence demonstrating the efficacy and safety of DOACs in older patients, there are still gray areas where the use of VKAs might be valuable

Association of Klotho with physical performance and frailty in middle-aged and older adults: A systematic review

Abstract Ageing is an inevitable process of physical deterioration that impairs functional autonomy and quality of life, becoming a public health issue. Since the percentage of people over 60 years is increasing worldwide, the use of easily detectable biomarkers of ageing is a relevant tool for monitoring of the ageing process and treatment. Among them, Klotho, an ageing suppressor gene because its deficiency leads to ageing like phenotype, seems particularly promising. This systematic review includes the last 10 years clinical studies that evaluated the association between plasma Klotho and body composition, physical performance and frailty in both sedentary and active middle-aged and older adults. Sixteen studies have been found: nine regarding the association between Klotho and body composition, two the association of Klotho and frailty and finally five concerning the effects of physical activity on Klotho. The results of these studies, albeit with some exceptions, point out that Klotho is positively associated with muscle strength and negatively with osteoporosis, frailty, disability and mortality while physical activity generally increases Klotho levels. Moreover, even if there are still few clinical studies, Klotho might be positively associated with bone mineral density, muscle strength, longevity, mobility and robustness during ageing

Lipids and physical function in older adults

PURPOSE OF REVIEW: Healthy aging is a public health priority. The maintenance of adequate physical function is recognized as a key element of healthy aging. In recent years, scientific evidence has increased concerning the ability of lipids, in particular omega 3 polyunsaturated fatty acids (n-3 PUFAs), to positively influence muscle and overall physical function in older patients. The article will critically review observational as well as intervention studies on this topic, and it will elucidate the potential biological mechanisms underlying the beneficial effects of n-3 PUFA on physical function. RECENT FINDINGS: Observational studies and clinical trials performed in healthy older patients and in older patients with chronic diseases mostly found positive effects of n-3 PUFA on muscle metabolism, muscle strength and in general physical function. SUMMARY: Although the use of n-3 PUFA might represent an important intervention to preserve physical function in older adults, several key questions still need to be answered. Above all, large randomized controlled trials should be performed to confirm the utility of n-3 PUFA as therapeutic agents to prevent and treat physical function decline in old age

Routines, Capabilities and Innovation in the Brazilian Wine Industry

As environments become more competitive and change, firms need to look for new ways of competing by implementing changes and innovations aiming at improving or even building new capabilities. Through multiple case studies, we examine the relationship between routines, capabilities and innovation seeking to identify the changes and innovations that have occurred along the trajectory of two wine producing firms in the Serra Gaúcha of Rio Grande do Sul, Brazil. The results indicate that both companies submitted changes/innovations in routines and capabilities, however, the different strategies and decisions made led to totally different outcomes in terms of size, growth and market-share

Acetyl-cholinesterase-inhibitors slow cognitive decline and decrease overall mortality in older patients with dementia

We evaluated the effect of Acetyl-cholinesterase-inhibitors (AChEIs) on cognitive decline and overall survival in a large sample of older patients with late onset Alzheimer's disease (LOAD), vascular dementia (VD) or Lewy body disease (LBD) from a real world setting. Patients with dementia enrolled between 2005 and 2020 by the "Alzheimer's Disease Research Centers" were analysed; the mean follow-up period was 7.9 years. A 1:1 propensity score matching was performed generating a cohort of 1.572 patients (786 treated [AChEIs +] and 786 not treated [AChEIs-] with AChEIs. The MMSE score was almost stable during the first 6 years of follow up in AChEIs + and then declined, while in AChEIs- it progressively declined so that at the end of follow-up (13.6 years) the average decrease in MMSE was 10.8 points in AChEIs- compared with 5.4 points in AChEIs + (p < 0.001). This trend was driven by LOAD (Delta-MMSE:-10.8 vs. -5.7 points; p < 0.001), although a similar effect was observed in VD (Delta-MMSE:-11.6 vs. -8.8; p < 0.001). No effect on cognitive status was found in LBD. At multivariate Cox regression analysis (adjusted for age, gender, dependency level and depression) a strong association between AChEIs therapy and lower all-cause mortality was observed (H.R.:0.59; 95%CI: 0.53-0.66); this was confirmed also in analyses separately conducted in LOAD, VD and LBD. Among older people with dementia, treatment with AChEIs was associated with a slower cognitive decline and with reduced mortality, after a mean follow-up of almost eight years. Our data support the effectiveness of AChEIs in older patients affected by these types of dementia

Evidence of and recommendations for non-pharmacological interventions for common geriatric conditions: the SENATOR-ONTOP systematic review protocol.

Introduction: Non-pharmacological therapies for common chronic medical conditions in older patients are underused in clinical practice. We propose a protocol for the assessment of the evidence of non-pharmacological interventions to prevent or treat relevant outcomes in several prevalent geriatric conditions in order to provide recommendations. Methods and analysis: The conditions of interest for which the evidence about efficacy of non-pharmacological interventions will be searched include delirium, falls, pressure sores, urinary incontinence, dementia, heart failure, orthostatic hypotension, sarcopaenia and stroke. For each condition, the following steps will be undertaken: (A) prioritising clinical questions; (B) retrieving the evidence (MEDLINE, the Cochrane Library, CINAHL and PsychINFO will be searched to identify systematic reviews); (C) assessing the methodological quality of the evidence (risk of bias according to the Cochrane method will be applied to the primary studies retrieved from the systematic reviews); (D) developing recommendations based on the evidence (Grading of Recommendations Assessment, Development and Evaluation (GRADE) items—risk of bias, imprecision, inconsistency, indirectness and publication bias—will be used to rate the overall evidence and develop recommendations). Dissemination: For each target condition, at least one systematic overview concerning the evidence of non-pharmacological interventions will be produced and published in peer-reviewed journals

Evidence of and recommendations for non-pharmacological interventions for common geriatric conditions : the SENATOR-ONTOP systematic review protocol

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.Peer reviewedPublisher PD

Set of procedures in oral health: origin, apogee and decline

Descreve-se o surgimento e o que significaram para a política nacional de saúde bucal os procedimentos coletivos (PC) de saúde bucal, introduzidos em 1992 e extintos em 2006. Realizou-se pesquisa bibliográfica e análise documental. Criados no governo Collor (1990-1992) como elemento central da sua política de saúde bucal, os PC pretendiam reverter o modelo assistencial cirúrgico-restaurador e extinguir o TC (tratamento completado) como instrumento para remuneração do setor, visando a possibilitar que estados e municípios fossem remunerados por ações preventivas. Durante os anos 1990, os PC ocuparam lugar de destaque nas ações de saúde bucal no SUS, impulsionando, sob apoio financeiro, as ações de promoção e prevenção em centenas de municípios. Mas a sua vinculação com os mecanismos de transferência de recursos, tida inicialmente como um avanço, foi tirando a sua característica de instrumento potente para mudar o modelo de atenção. Não obstante as dificuldades e limitações, sua criação e amplo emprego representaram um esforço para alterar substancialmente o modelo de prática odontológica predominante no setor público, redirecionando-o para ações preventivas e de promoção da saúde, o que se tornou seu principal legado.In order to analize the significance to the oral health national policy of the set of procedures in oral health, introduced in 1992 and extinguished in 2006, a bibliographic research and a documental analysis were carried out. Created in Collor's government as the central element of the oral health policy, which intended to reverse the surgical-restorative socialized model and extinguish the so-called 'finished treatment' as an instrument for remuneration in the area, the set of procedures aimed at enabling states and towns to be remunerated for preventive actions. During the 90s the set of procedures occupied an important position among the oral health actions of the 'SUS' (National Health System), thus stimulating, under financial support, promotional and preventive actions at hundreds of towns. However, its connection with the mechanisms of resource transfer, which was initially regarded as a step forward, gradually removed its characteristic of being instrumental in changing the kind of treatment. In spite of difficulties and limitations, its creation and widespread use did represent an effort to substantially modify the model of dentistry practice prevailing in the public health area, redirecting it to health preventive and promotional actions - which became its major legacy

Discontinuously supervised aerobic training vs. physical activity promotion in the self-management of type 2 diabetes in older Italian patients: design and methods of the 'TRIPL-A' randomized controlled trial

Physical activity (PA) has health benefits for people with type 2 diabetes (T2D). Indeed, regular PA is considered an important part of any T2D management plan, yet most patients adopt a sedentary lifestyle. Exercise referral schemes (ERS) have the potential to effectively promote physical activity among T2D patients, and their effectiveness may be enhanced when they are supported by computer-based technologies. The 'TRIPL-A' study (i.e., a TRIal to promote PhysicaL Activity among patients in the young-old age affected by T2D) aims to assess if realizing an innovative ERS, based on a strong partnership among general practitioners, specialist physicians, exercise specialists, and patients, and supported by a web-based application (WBA), can effectively lead sedentary older T2D patients to adopt an active lifestyle