Articles: aged.
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Eur. J. Intern. Med. · Dec 2018
ReviewMonoclonal gammopathies of unknown significance and smoldering myeloma: Assessment and management of the elderly patients.
Monoclonal gammopathy of unknown significance (MGUS) is the most frequent plasma cell disorder that commonly affects elderly patients. Although it is an asymptomatic condition, as well as smoldering myeloma (SMM), the risk of progression to multiple myeloma requiring therapy or other B-cell disorders varies greatly for individual patients, remaining low for MGUS (1% per year), while higher and not uniform for SMM patients (10% per year). This scenario implies some special considerations regarding assessment and follow-up, especially in the elderly. ⋯ Finally, the identification of predictor markers of progression has enabled a proposal of risk-adapted follow-up strategies in MGUS and SMM that should be implemented in clinical practice. Although the standard of care is observation for MGUS and SMM patients as well, a recent randomized trial targeting high-risk SMM showed the clinical benefit of early intervention. The change of the treatment paradigm is also very promising and feasible for elderly patients, as long as a comprehensive geriatric assessment is conducted to optimize early treatment and reach maximum benefit with minimum toxicity, in other words, to ensure a better quality of life for these patients.
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To study the effect of caregiver-focused interventions to support medication safety in older adults with chronic disease. ⋯ Although some interventions improved caregiver medication knowledge and self-efficacy, effects on clinical outcomes and healthcare use were insufficiently studied. Two studies implementing collaborative care models with medication management components showed potential for improvement in quality of clinical care and reductions in healthcare visits and warrant further study with respect to medication safety. J Am Geriatr Soc 66:2128-2135, 2018.
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Critical care clinics · Oct 2018
ReviewFrailty and the Association Between Long-Term Recovery After Intensive Care Unit Admission.
Frailty is common, although infrequently screened for among patients admitted to intensive care. Frailty has been the focus of research in geriatric medicine; however, its epidemiology and interaction with critical illness have only recently been studied. ⋯ Frail survivors of critical illness are high users of health resources. Further research is needed to understand how frailty assessment can inform decision-making before and during an episode of critical illness and during an intensive care course for frail patients.
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Breast Cancer Res. Treat. · Oct 2018
Review Meta AnalysisPatient-reported factors influencing the treatment decision-making process of older women with non-metastatic breast cancer: a systematic review of qualitative evidence.
Older women (≥ 70 years old) with breast cancer undergo different treatments than young women. Studies have examined factors that influence this disparity, but synthesized patient-reported data are lacking in the literature. This study aims to identify, appraise, and synthesize the existing qualitative evidence on patient-reported factors influencing older women's decision to accept or decline breast cancer treatment. ⋯ This systematic review highlights the complexity of factors that influence an older woman's treatment decision-making process. Acknowledging and addressing these factors may improve discussions about treatment choices between older women and their health care providers, and encourage maximization of a patient-centered approach.