scholarly journals Cancer screenings still conducted in older patients with limited life expectancy

Cancer ◽  
2015 ◽  
Vol 121 (3) ◽  
pp. 327-327
Author(s):  
Carrie Printz
Keyword(s):  
Life Expectancy ◽  
Older Patients ◽  
Limited Life Expectancy ◽  
Cancer Screenings ◽  
Limited Life

scholarly journals Health care professionals' attitudes towards deprescribing in older patients with limited life expectancy: A systematic review

2019 ◽  
Vol 85 (5) ◽  
pp. 868-892 ◽  
Author(s):  
Carina Lundby ◽  
Trine Graabæk ◽  
Jesper Ryg ◽  
Jens Søndergaard ◽  
Anton Pottegård ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Life Expectancy ◽  
Health Care Professionals ◽  
Older Patients ◽  
Limited Life Expectancy ◽  
Limited Life

scholarly journals “… Above All, It’s a Matter of  This Person’s Quality of Life”: Health Care Professionals’ Perspectives on Deprescribing in Older Patients With Limited Life Expectancy

2019 ◽  
Vol 60 (3) ◽  
pp. 439-449 ◽  
Author(s):  
Carina Lundby ◽  
Trine Graabæk ◽  
Jesper Ryg ◽  
Jens Søndergaard ◽  
Anton Pottegård ◽  
...  
Keyword(s):  
Health Care ◽  
Life Expectancy ◽  
Older People ◽  
Health Care Professionals ◽  
Older Patients ◽  
Full Spectrum ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Primary Responsibility ◽  
Group Interviews

Abstract Background and Objectives Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients’ medication. Thus, we aimed to explore different HCPs’ perspectives on deprescribing in older patients with limited life expectancy. Research Design and Methods Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. Results A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs’ perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Discussion and Implications Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved.

Potential Overdiagnosis of Basal Cell Carcinoma in Older Patients With Limited Life Expectancy

JAMA ◽  
2014 ◽  
Vol 312 (10) ◽  
pp. 997 ◽  
Author(s):  
Eleni Linos ◽  
Steven A. Schroeder ◽  
Mary-Margaret Chren
Keyword(s):  
Basal Cell Carcinoma ◽  
Life Expectancy ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Older Patients ◽  
Limited Life Expectancy ◽  
Limited Life

Does deprescribing in older people improve outcomes?

2020 ◽  
Vol 58 (9) ◽  
pp. 132-132
Keyword(s):  
Systematic Review ◽  
Life Expectancy ◽  
Older People ◽  
Older Patients ◽  
Limited Life Expectancy ◽  
Limited Life

AbstractReview of: Shrestha S, Poudel A, Steadman K, et al. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: a systematic review. Br J Clin Pharmacol 2019; doi: 10.1111/bcp.14113 [Epub ahead of print 4 September 2019].

scholarly journals ReCAP: Hospitalizations in Older Adults With Advanced Cancer: The Role of Chemotherapy

2016 ◽  
Vol 12 (2) ◽  
pp. 151-152 ◽  
Author(s):  
Caitriona B. O’Neill ◽  
Coral L. Atoria ◽  
Eileen M. O’Reilly ◽  
Martin C. Henman ◽  
Peter B. Bach ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Adverse Effects ◽  
Advanced Cancer ◽  
Older Patients ◽  
Metastatic Cancer ◽  
Hazard Ratio ◽  
Limited Life Expectancy ◽  
Limited Life

CONTEXT AND QUESTION ASKED: In patients with metastatic cancer, chemotherapy may provide symptom control, prevent complications, prolong life, or improve quality of life. Except in rare cases, however, patients with metastatic disease will not be cured. In older patients with metastatic cancer, hospitalization for treatment toxicity may reduce the quality of an already limited life expectancy. We evaluated the association between chemotherapy for metastatic cancer and risk of hospitalization. MAIN CONCLUSION: Hospitalizations are common in patients with incurable advanced malignancies and are more likely among those who receive chemotherapy. APPROACH: In the linked SEER-Medicare dataset, we identified Medicare beneficiaries aged 66 years or older with a primary diagnosis of metastatic breast, colorectal, ovarian, bladder, lung, pancreas, esophageal, stomach, or prostate cancer between 2001 and 2009 who died by the end of 2010. Chemotherapy recipients and nonrecipients were pair-matched by age, sex, race, comorbidity, geographic region and survival duration. The primary endpoint was hospital admission, identified in inpatient claims between cancer diagnosis and the first of hospice admission or death. We also identified the subset of admissions associated with a primary or secondary diagnosis code suggestive of an adverse effect of chemotherapy. The association between chemotherapy and hospitalization was estimated in separate multivariable Cox proportional-hazards regression models for each cancer site, accounting for the matched-pairs design and controlling for unmatched demographic and disease characteristics. RESULTS: Of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity. The corresponding rates among matched non-recipients were 83% and 34% (Figure). In nearly all cancers, chemotherapy recipients had a greater risk of hospitalization for a likely toxicity or for any cause. Chemotherapy recipients had substantially higher hospitalization for infection or fever (21% v 15%), hematologic complications (11% v 3%), dehydration (13% v 6%), and PE or DVT (9% v 4%) compared with nonrecepients. Chemotherapy was associated with a significantly increased risk of likely toxicity-related hospitalization in nearly all cancers, controlling for sociodemographic characteristics and other treatment. The association was greatest in patients with metastatic esophageal cancer (adjusted hazard ratio, 2.00; 95% CI, 1.11 to 3.60) and smallest in patients with metastatic prostate cancer (adjusted hazard ratio, 1.22; 95% CI, 1.01 to 1.47). INTERPRETATION: Older patients receiving chemotherapy for incurable advanced cancers are at high risk of hospitalization, of which a non-negligible proportion is likely attributable to adverse effects of treatment. Infection, fever, dehydration, and hematologic complications constitute a large proportion of these events, some of which may be preventable through evidence-based patient management, prophylactic interventions, and effective outpatient care. Our findings might be limited to older patients with advanced cancer who have a generally poor prognosis or limited expected survival. SIGNIFICANCE OF FINDINGS: Understanding the common reasons for hospital admissions and developing toxicity management programs and educational resources may help patients and their families make informed treatment decisions, minimize adverse effects and reduce hospitalizations in this population with limited life expectancy. [Figure: see text]

scholarly journals Who Orders Screening Mammograms in Older Women with Limited Life Expectancy?

2019 ◽  
Vol 34 (12) ◽  
pp. 2720-2722 ◽  
Author(s):  
Nancy L. Schoenborn ◽  
Jin Huang ◽  
Cynthia M. Boyd ◽  
Sarah Nowak ◽  
Craig E. Pollack
Keyword(s):  
Life Expectancy ◽  
Older Women ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Screening Mammograms

Drugs and prescribing in the older patient

2020 ◽  
pp. 571-578
Author(s):  
Miles Witham ◽  
Jacob George ◽  
Denis O’Mahony
Keyword(s):  
Side Effects ◽  
Life Expectancy ◽  
Drug Metabolism ◽  
Older People ◽  
Drug Interactions ◽  
Central Component ◽  
Pharmacological Agents ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Great Harm

The use of pharmacological agents is often a central component of medical therapy for older people. Medications can relieve symptoms, improve function, and prevent illness, but they also have the capacity to inflict great harm. Older people are at particular risk of such harms as a result of impaired homeostatic reserve, of altered drug metabolism, the presence of multimorbidity and consequent polypharmacy, which increases both exposure to potentially harmful agents and the chance of drug–drug interactions. The therapeutic priorities for older, frail people may differ when compared to younger, robust patients; limited life expectancy means that attempts to prolong life may become relatively less important than the relief of symptoms and avoidance of side effects and medication burden.

scholarly journals Need for Deprescribing in Hospital Elderly Patients Discharged with a Limited Life Expectancy: The REPOSI Study

2019 ◽  
Vol 28 (6) ◽  
pp. 501-508 ◽  
Author(s):  
Luca Pasina ◽  
Barbara Brignolo Ottolini ◽  
Laura Cortesi ◽  
Mauro Tettamanti ◽  
Carlotta Franchi ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Life Expectancy ◽  
Elderly Patients ◽  
End Of Life ◽  
Drug Prescription ◽  
Inappropriate Medication ◽  
Lipid Lowering ◽  
Limited Life Expectancy ◽  
Limited Life ◽  
Preventive Medication

Objective: Older people approaching the end of life are at a high risk for adverse drug reactions. Approaching the end of life should change the therapeutic aims, triggering a reduction in the number of drugs.The main aim of this study is to describe the preventive and symptomatic drug treatments prescribed to patients discharged with a limited life expectancy from internal medicine and geriatric wards. The secondary aim was to describe the potentially severe drug-drug interactions (DDI). Materials and Methods: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with a limited life expectancy. Results: The study sample comprised 55 patients discharged with a limited life expectancy. Patients with at least 1 preventive medication that could be considered for deprescription at the end of life were significantly fewer from admission to discharge (n = 30; 54.5% vs. n = 21; 38.2%; p = 0.02). Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs, and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least 1 potentially severe DDI at discharge. Conclusion: Hospital discharge is associated with a small reduction in the use of commonly prescribed preventive medications in patients discharged with a limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.

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