Pub Date : 2012-08-01DOI: 10.1017/S0959259812000032
D. Tiwari, J. Radvan, S. Allen
{"title":"Aortic stenosis: current treatment options for a common condition in old age","authors":"D. Tiwari, J. Radvan, S. Allen","doi":"10.1017/S0959259812000032","DOIUrl":"https://doi.org/10.1017/S0959259812000032","url":null,"abstract":"","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"195-203"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259812000032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57028495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-08-01DOI: 10.1017/S0959259812000056
H. Slavin, J. McManus, D. Stott
‘Cerebral small vessel disease’ is common in older adults and is an important cause of morbidity, functional impairment and cognitive decline. Small vessel disease is a collective term used to describe a number of underlying pathological processes and neuroimaging findings, such as lacunar infarcts, white matter lesions and microhaemorrhages.With readily available neuroimaging, diagnostic accuracy has improved; however, the management of small vessel disease and prevention of cognitive decline remains uncertain. Treatment of conventional vascular risk factors may be appropriate, but future research is required to provide definitive answers. We have conducted a comprehensive literature review of cerebral small vessel disease in older adults. This highlights the clinical sequelae and underlying pathological processes, whilst discussing novel diagnostic neuroimaging and therapeutic strategies.
{"title":"Small vessel cerebrovascular disease in older adults","authors":"H. Slavin, J. McManus, D. Stott","doi":"10.1017/S0959259812000056","DOIUrl":"https://doi.org/10.1017/S0959259812000056","url":null,"abstract":"‘Cerebral small vessel disease’ is common in older adults and is an important cause of morbidity, functional impairment and cognitive decline. Small vessel disease is a collective term used to describe a number of underlying pathological processes and neuroimaging findings, such as lacunar infarcts, white matter lesions and microhaemorrhages.With readily available neuroimaging, diagnostic accuracy has improved; however, the management of small vessel disease and prevention of cognitive decline remains uncertain. Treatment of conventional vascular risk factors may be appropriate, but future research is required to provide definitive answers. We have conducted a comprehensive literature review of cerebral small vessel disease in older adults. This highlights the clinical sequelae and underlying pathological processes, whilst discussing novel diagnostic neuroimaging and therapeutic strategies.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"184-194"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259812000056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57028094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0959259811000244
J. Browning, Z. Zaheer, A. Orzechowska, A. Mistri
Urinary incontinence is a common problem, more so in older people and those in residential or nursing homes. Guidelines promote a structure to the management of incontinence, recommending non-pharmacological measures (including continence aids) as first-line options. Anticholinergic medications are used widely for urge incontinence, and surgical measures employed in selective cases.Whilst other treatments are being tried, or where incontinence is refractory to treatment (about 30% of cases), it is important to promote continence or contain incontinence with continence aids in order to minimize psychological complications. What can be a bewildering array of aids is available and choosing the right type of aid requires knowledge of these. Here, we suggest a classification of continence aids, describing individual characteristics and appropriate situations for use.
{"title":"Continence aids in the management of urinary incontinence","authors":"J. Browning, Z. Zaheer, A. Orzechowska, A. Mistri","doi":"10.1017/S0959259811000244","DOIUrl":"https://doi.org/10.1017/S0959259811000244","url":null,"abstract":"Urinary incontinence is a common problem, more so in older people and those in residential or nursing homes. Guidelines promote a structure to the management of incontinence, recommending non-pharmacological measures (including continence aids) as first-line options. Anticholinergic medications are used widely for urge incontinence, and surgical measures employed in selective cases.Whilst other treatments are being tried, or where incontinence is refractory to treatment (about 30% of cases), it is important to promote continence or contain incontinence with continence aids in order to minimize psychological complications. What can be a bewildering array of aids is available and choosing the right type of aid requires knowledge of these. Here, we suggest a classification of continence aids, describing individual characteristics and appropriate situations for use.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"85-98"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57027611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0959259811000281
J. Lally, E. Tullo
Shared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values. Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.
{"title":"Engaging older people in decisions about their healthcare: the case for shared decision making","authors":"J. Lally, E. Tullo","doi":"10.1017/S0959259811000281","DOIUrl":"https://doi.org/10.1017/S0959259811000281","url":null,"abstract":"Shared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values. Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"99-107"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57028194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0959259811000256
W. Osborne, G. Jones, G. Jackson, H. Marr
{"title":"Myeloproliferative disorders in older people","authors":"W. Osborne, G. Jones, G. Jackson, H. Marr","doi":"10.1017/S0959259811000256","DOIUrl":"https://doi.org/10.1017/S0959259811000256","url":null,"abstract":"","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"108-118"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57027786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0959259811000232
M. Woodward
Insomnia and other sleep disturbances are common in older people, with up to 40% reporting some difficulty sleeping. Insomnia is a syndrome with multiple causes including medications, other illnesses and environmental factors. An accurate diagnosis is needed for effective management. Sleep disturbances are associated with functional and cognitive impairment and excess mortality. Management should initially be non-pharmacological including sleep hygiene education and behavioural therapy. Medications, including benzodiazepines (BZDs), are second-line with little evidence to support long-term usage. BZD usage in older people is associated with a range of disorders including falls, accidents and cognitive impairment. The management of insomnia in specific situations such as residential care, those with dementia and depressed older people can be challenging. Additional research is needed, particularly on the risks/benefit of long-term pharmacotherapy and to determine whether therapy reduces the consequences of sleep disturbances.
{"title":"Sleep in older people","authors":"M. Woodward","doi":"10.1017/S0959259811000232","DOIUrl":"https://doi.org/10.1017/S0959259811000232","url":null,"abstract":"Insomnia and other sleep disturbances are common in older people, with up to 40% reporting some difficulty sleeping. Insomnia is a syndrome with multiple causes including medications, other illnesses and environmental factors. An accurate diagnosis is needed for effective management. Sleep disturbances are associated with functional and cognitive impairment and excess mortality. Management should initially be non-pharmacological including sleep hygiene education and behavioural therapy. Medications, including benzodiazepines (BZDs), are second-line with little evidence to support long-term usage. BZD usage in older people is associated with a range of disorders including falls, accidents and cognitive impairment. The management of insomnia in specific situations such as residential care, those with dementia and depressed older people can be challenging. Additional research is needed, particularly on the risks/benefit of long-term pharmacotherapy and to determine whether therapy reduces the consequences of sleep disturbances.","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"524 1","pages":"130-149"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57027967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-05-01DOI: 10.1017/S0959259812000020
J. Browning, Z. Zaheer, A. Orzechowska, A. Mistri
{"title":"Continence aids in the management of urinary incontinence – CORRIGENDUM","authors":"J. Browning, Z. Zaheer, A. Orzechowska, A. Mistri","doi":"10.1017/S0959259812000020","DOIUrl":"https://doi.org/10.1017/S0959259812000020","url":null,"abstract":"","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"98-98"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259812000020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57028364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01Epub Date: 2012-08-24DOI: 10.1017/S0959259811000165
Andrew P Clegg, Sally E Barber, John B Young, Anne Forster, Steve J Iliffe
Background: Frailty is common in older age, and is associated with important adverse health outcomes including increased risk of disability and long-term care admission.
Objectives: To evaluate whether home-based exercise interventions improve outcomes for frail older people.
Data sources: We searched systematically for randomised controlled trials (RCTs) and cluster RCTs, with literature searching to February 2010.
Study selection: All trials that evaluated home-based exercise interventions for frail older people were eligible. Primary outcomes were mobility, quality of life and daily living activities. Secondary outcomes included long-term care admission and hospitalisation.
Results: Six RCTs involving 987 participants met the inclusion criteria. Four trials were considered of high quality. One high quality trial reported improved disability in those with moderate but not severe frailty. Meta-analysis of long-term care admission rates identified a trend towards reduced risk. Inconsistent effects on other primary and secondary outcomes were reported in the other studies.
Conclusions: There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate, but not severe, frailty. There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission. Home-based exercises are a potentially simple, safe and widely applicable intervention to prevent dependency decline for frail older people.
{"title":"Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review.","authors":"Andrew P Clegg, Sally E Barber, John B Young, Anne Forster, Steve J Iliffe","doi":"10.1017/S0959259811000165","DOIUrl":"https://doi.org/10.1017/S0959259811000165","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common in older age, and is associated with important adverse health outcomes including increased risk of disability and long-term care admission.</p><p><strong>Objectives: </strong>To evaluate whether home-based exercise interventions improve outcomes for frail older people.</p><p><strong>Data sources: </strong>We searched systematically for randomised controlled trials (RCTs) and cluster RCTs, with literature searching to February 2010.</p><p><strong>Study selection: </strong>All trials that evaluated home-based exercise interventions for frail older people were eligible. Primary outcomes were mobility, quality of life and daily living activities. Secondary outcomes included long-term care admission and hospitalisation.</p><p><strong>Results: </strong>Six RCTs involving 987 participants met the inclusion criteria. Four trials were considered of high quality. One high quality trial reported improved disability in those with moderate but not severe frailty. Meta-analysis of long-term care admission rates identified a trend towards reduced risk. Inconsistent effects on other primary and secondary outcomes were reported in the other studies.</p><p><strong>Conclusions: </strong>There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate, but not severe, frailty. There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission. Home-based exercises are a potentially simple, safe and widely applicable intervention to prevent dependency decline for frail older people.</p>","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"68-78"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34518679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-02-01DOI: 10.1017/S0959259811000207
J. Neal
{"title":"Vascular dementia: why pathology is still important","authors":"J. Neal","doi":"10.1017/S0959259811000207","DOIUrl":"https://doi.org/10.1017/S0959259811000207","url":null,"abstract":"","PeriodicalId":85413,"journal":{"name":"Reviews in clinical gerontology","volume":"22 1","pages":"35-51"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0959259811000207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57027579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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