Effect of #Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among #Older Adults
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2628971#161129788

Question Are statins beneficial when used for primary cardiovascular prevention in older adults?

Importance While statin therapy for primary cardiovascular prevention has been associated with reductions in cardiovascular morbidity, the effect on all-cause mortality has been variable. There is little evidence to guide the use of statins for primary prevention in adults 75 years and older.

Conclusions and Relevance No benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.

Comparisons of Interventions for Preventing #Falls in #Older Adults
A Systematic Review and Meta-analysis
https://jamanetwork.com/journals/jama/article-abstract/2661578

Falls result in substantial burden for patients and health care systems, and given the aging of the population worldwide, the incidence of falls continues to rise Network meta-analysis (including 54 RCTs, 41 596 participants, 39 interventions plus usual care) suggested that the following interventions, when compared with usual care, were associated with reductions in injurious falls: exercise (odds ratio OR, 0.51 95% CI, 0.33 to 0.79; absolute risk difference ARD, −0.67 95% CI, −1.10 to −0.24); combined exercise and vision assessment and treatment (OR, 0.17 95% CI, 0.07 to 0.38; ARD, −1.79 95% CI, −2.63 to −0.96); combined exercise, vision assessment and treatment, and environmental assessment and modification (OR, 0.30 95% CI, 0.13 to 0.70; ARD, −1.19 95% CI, −2.04 to −0.35); and combined clinic-level quality improvement strategies (eg, case management), multifactorial assessment and treatment (eg, comprehensive geriatric assessment), calcium supplementation, and vitamin D supplementation (OR, 0.12 95% CI, 0.03 to 0.55; ARD, −2.08 95% CI, −3.56 to −0.60). Pairwise meta-analyses for fall-related hospitalizations (2 RCTs; 516 participants) showed no significant association between combined clinic- and patient-level quality improvement strategies and multifactorial assessment and treatment relative to usual care (OR, 0.78 95% CI, 0.33 to 1.81).

Conclusions and Relevance Exercise alone and various combinations of interventions were associated with lower risk of injurious falls compared with usual care. Choice of fall-prevention intervention may depend on patient and caregiver values and preferences

Deprescribing #antihyperglycemic agents in #older persons
Evidence-based clinical practice guideline

http://www.cfp.ca/content/63/11/832?

These recommendations apply to all elderly (> 65 y) adults taking ≥ 1 antihyperglycemic medications to treat type 2 diabetes and meeting ≥ 1 of the following criteria:

at risk of hypoglycemia (eg, owing to advancing age, overly intense glycemic control, multiple comorbidities, drug interactions, hypoglycemia history or lack of awareness, impaired renal function, or taking a sulfonylurea or insulin);

at risk of other antihyperglycemic adverse effects; or

in whom benefit is uncertain owing to frailty, dementia, or limited life expectancy

We recommend the following:

Deprescribing antihyperglycemic agents that are known to contribute to hypoglycemia (strong recommendation, very low-quality evidence)

Deprescribing antihyperglycemic agents in patients experiencing or at risk of adverse effects (good practice recommendation)

Individualizing glycemic targets to goals of care and time to benefit according to the Canadian Diabetes Association guidelines and other guidelines that specifically address frailty, dementia, and the end of life (good practice recommendation), and deprescribing accordingly (strong recommendation, very low-quality evidence)

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Efficacy and safety of #statin therapy in #older people: a meta-analysis of individual participant data from 28 randomised controlled trials

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext

Statin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safety among older people. We undertook a meta-analysis of data from all large statin trials to compare the effects of statin therapy at different ages.

The proportional reduction in major vascular events was similar, irrespective of age, among patients with pre-existing vascular disease (ptrend=0·2), but appeared smaller among older than among younger individuals not known to have vascular disease (ptrend=0·05). We found a 12% (RR 0·88, 95% CI 0·85–0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a trend towards smaller proportional reductions with older age (ptrend=0·004), but this trend did not persist after exclusion of the heart failure or dialysis trials (ptrend=0·2). Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence.
Interpretation

Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials

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The Predictive Performance of Objective Measures of #physical Activity Derived From Accelerometry Data for 5-Year All-Cause Mortality in #Older Adults: National Health and Nutritional Examination Survey 2003–2006

Declining physical activity (PA) is a hallmark of aging. Wearable technology provides reliable measures of the frequency, duration, intensity, and timing of PA..

In univariate logistic regression, the total activity count was the best predictor of 5-year mortality (Area under the Curve (AUC) = 0.771) followed by age (AUC = 0.758). Overall, 9 of the top 10 predictors were objective PA measures (AUC from 0.771 to 0.692). In multivariate regression, the 10-fold cross-validated AUC was 0.798 for the model without objective PA variables (9 predictors) and 0.838 for the forward selection model with objective PA variables (13 predictors). The Net Reclassification Index was substantially improved by adding objective PA variables (p < .001).

Conclusions
Objective accelerometry-derived PA measures outperform traditional predictors of 5-year mortality, including age. This highlights the importance of wearable technology for providing reproducible, unbiased, and prognostic biomarkers of health.

https://academic.oup.com/biomedgerontology/advance-article-abstract/doi/10.1093/gerona/glz193/5555985

Factors associated with social #isolation and being homebound among #older patients with #diabetes: a cross-sectional study
https://2medical.news/2020/11/10/factors-associated-with-social-isolation-and-being-homebound-among-older-patients-with-diabetes-a-cross-sectional-study/

We aimed at investigating factors associated with social isolation and being homebound in older patients with diabetes.. ..Social isolation was defined as indulging in less than one interaction per week with individuals other than cohabiting family members. We defined homebound as going outside home less than once a day. To identify factors associated with social isolation and being homebound, we performed logistic regression analysis. The …

#Older age does not influence the success of #weight loss through the implementation of lifestyle modification
https://2medical.news/2020/12/07/older-age-does-not-influence-the-success-of-weight-loss-through-the-implementation-of-lifestyle-modification/

Age is sometimes a barrier for acceptance of patients into a hospital‐based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital‐based obesity service.. Primary outcome measures were percentage weight loss (%WL) and percentage reduction in body mass index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age …

Low #muscle mass in #older adults and mortality: A systematic review and meta-analysis

https://2medical.news/2021/07/02/low-muscle-mass-in-older-adults-and-mortality-a-systematic-review-and-meta-analysis/

Association Between #Triglycerides and Risk of #Dementia in Community-Dwelling #Older Adults: A Prospective Cohort Study

https://2medical.news/2023/10/30/association-between-triglycerides-and-risk-of-dementia-in-community-dwelling-older-adults-a-prospective-cohort-study/

#Circadian disturbances and #frailty risk in #older adults

https://2medical.news/2023/11/20/circadian-disturbances-and-frailty-risk-in-older-adults/