Journal of the American Geriatrics Society
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Review Comparative Study
A cost-effectiveness comparison of desipramine, gabapentin, and pregabalin for treating postherpetic neuralgia.
To compare the net health effects and costs resulting from treatment with different first-line postherpetic neuralgia (PHN) medications. ⋯ Desipramine appears to be more effective and less expensive than gabapentin or pregabalin for the treatment of older patients with PHN in whom it is not contraindicated. After its price falls, generic gabapentin will likely be more cost-effective than pregabalin.
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Review
Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept.
Geriatricians have embraced the term "geriatric syndrome," using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. ⋯ Understanding basic mechanisms involved in geriatric syndromes will be critical to advancing research and developing targeted therapeutic options, although given the complexity of these multifactorial conditions, attempts to define relevant mechanisms will need to incorporate more-complex models, including a focus on synergistic interactions between different risk factors. Finally, major barriers have been identified in translating research advances, such as preventive strategies of proven effectiveness for delirium and falls, into clinical practice and policy initiatives. National strategic initiatives are required to overcome barriers and to achieve clinical, research, and policy advances that will improve quality of life for older persons.
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Review
Interventions to reduce fear of falling in community-living older people: a systematic review.
The objective was to assess which interventions effectively reduce fear of falling in community-living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community-living older people were included. ⋯ Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community-living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home-based exercise and fall-related multifactorial programs and community-based tai chi delivered in group format have been effective in reducing fear of falling in community-living older people.
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Delirium is a common postoperative complication in older adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this article is to systematically review preoperative risk factors associated with delirium following noncardiac surgery. A medical literature search was conducted using several bibliographic databases (PubMed, CINAHL, Cochrane, PsychInfo), supplemented by a manual search of the references of retrieved articles. ⋯ Missing data and measurement differences did not allow for inferences to be made about other risk factors. Effect-size pooling supports the concept that delirium is a heterogeneous disorder with multiple risk factors. More research is needed to better identify patients at risk for postoperative delirium and to develop preventive strategies.
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Age-related macular degeneration (AMD) is the leading cause of blindness in older North Americans. The clinical spectrum, risk factors, pathophysiology, and potential therapeutic options for AMD warrant a careful review. ⋯ In addition, a low-vision assessment to investigate the potential use of visual assistive devices may be beneficial to any patient who has experienced a decrease in vision. Finally, education regarding the clinical course of age-related macular degeneration and accurate information with respect to the known benefits of available treatments will impart a better understanding of this disease to patients.