BMC Geriatrics: highlights of 2017

As 2018 begins we take a look back at some of the most interesting research published in the journal in 2017. As the average life expectancy has increased to its highest ever level, geriatrics-focused research is now more important and prevalent than ever before. Here we look back at five articles worth revisiting in BMC Geriatrics.

High use of medications in Norwegian nursing homes

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While the use of psychotropic drugs in European nursing homes is reported to be common, few studies have examined the prevalence and persistency of psychotropic drug use in nursing home residents. Among nursing home residents with dementia or cognitive impairment, the prevalence of any psychotropic drug use is similar to or even higher than among those with normal cognition. However, there is limited research surrounding the use of psychotropic drugs in a longitudinal design.

In a 72-month longitudinal study carried out by Helvik et al., the researchers found persistent and highly prevalent use of psychotic drugs across 26 nursing homes in Norway. They found the use of conventional antipsychotics did not differ between residents with or without dementia at any time point, and that at two consecutive time points, the use of both atypical and conventional antipsychotics was as high as 50%. Furthermore, they also revealed that less-severe dementia was associated with persistent use of sedatives.

The researchers concluded that this highly prevalent use of psychotropic drugs may indicate that treatment is not in line with current recommendation, and that clinicians should monitor effects of psychotropic drug treatment and be prepared to stop treatment when the risk of use is not balanced by significant benefits to the patient.

Physical activity among hospitalized older adults

Hospitalisation due to present disease has been shown to be a risk factor for loss of ambulatory ability in older adults. Previous studies have found that geriatric patients have a low level of psychical activity when hospitalised, spending around only 3.7-5.8% of their day either standing or walking (<83 minutes). This low level of activity is often associated with worse prognosis in patients.

In their observational study, Evensen and colleagues found that time spent upright by 38 patients was higher than had previously been reported in comparable studies, with patients spending almost two hours upright each day. Their findings show no association between age, cognitive impairment, burden of comorbidity and physical activity, highlighting that it is possible to mobilize even acutely admitted geriatric patients. Ultimately, further research is needed to evaluate if mobilization regimes could improve outcomes in geriatric patients.

Mental health determines well-being in later life

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Subjective well-being refers to a person’s positive evaluation of their psychological functioning and experience, as well as the absence of mental illness. Debated findings have shown that in Western countries, well-being reaches its minimum around midlife due to the onset of adverse life events such as mental and physical decline, disease and disability, as well as loss of independence and companionship – factors that increase with age. Therefore, as life expectancy increases, the new challenge of understanding factors that affect well-being in older adults emerges.

In this study, Lukaschek et al. found within their sample of over 3,600 participants, 79% reported high levels of subjective well-being. Their analysis also showed lower levels of subjective well-being in older women than men, with low income, physical inactivity, depression, anxiety and sleeping problems associated with low well-being in both sexes. However, the impact of living alone was only shown to affect subjective well-being in older women, possibly due to the fact women place greater value on social ties than men.

Their research highlights the need for an increased focus on preventative health interventions among older adults, especially in women living alone.

Interactions between alcohol and prescribed medications in older adults

Alcohol use is rising in older adults, a population especially at risk of harm from drinking.  A systematic review by Holton et al. aimed to estimate the prevalence of the use of alcohol with alcohol-interacting medications in this population.  They found that as many as one third of older adults are at risk of interactions between alcohol and prescribed medications, indicating a need for more longitudinal studies to examine associations with adverse outcomes.

Another interesting lack highlighted by the systematic review is a lack of a definitive list of alcohol-interacting medications.   The studies included used diverse lists, which hampered the determination of prevalence.  Additionally, a definitive, validated list would allow the development of guidelines for determining risk when prescribing and for alcohol interventions in high-risk groups.

Dying comfortably related to place of care

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Comfort is an important factor in what many perceive to be important for a good death, with almost 92% of older adults prioritizing comfort when planning in advance for this time. While dying at home is often stated as a preference, in actuality a minority of older people die in their own homes.

In the UK, fewer older people die in hospices or receive specialist palliative care at home than younger age-groups and the trend for older deaths is gradually moving away from death in hospital towards long-term care facilities. Furthermore, those with cognitive impairment are most likely to live in and subsequently die in care homes, while those with no or mild cognitive impairment are more likely to live at home and then be admitted into facilities during their final days.

Researchers based in Cambridge investigated how physical and cognitive disability, place of care and place of death related to reported comfort in very old people’s final illness. In interviews with relatives/close carers after a patient passed, 44% were described as having been “comfortable” during their illness, whilst only 7% of relative described the deceased as having been “uncomfortable”.  Patients were also four times as likely to have been described as comfortable if they died in a care home or their own home, compared with a hospital.

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