Improving clinical practice guidelines for older people: considerations and recommendations for more inclusive and ageing-relevant guidelines

Hwang, Kerry; Moore, Kirsten; Chong, Terence W.H.; Williams, Sue; Batchelor, Frances

doi:10.1016/s2666-7568(22)00074-5

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Often, these patients are being managed in a highly fragmented manner, with each healthcare professional focused on a single pathology and, therefore, these patients are subjected to a greater number of negative outcomes [ 13 ]. As results of a systematic review [ 42 ], a wide range of healthcare components were found to have the potential to improve services: individual care plans, thorough geriatric assessments, and the application of shared decision-making [ 37 , 43 , 44 ]. Here, the priority for health systems is to deliver people-centred primary care services.…”

Section: Discussionmentioning

confidence: 99%

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

Batista,

Sousa,

Nunes

et al. 2024

BMC Geriatr

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Background In ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce. Objective This study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians. Methods A national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software. Results The majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health. Conclusion Our findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

Batista,

Sousa,

Nunes

et al. 2024

BMC Geriatr

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“…In patients without obvious signs of trauma or a known fall or diving event, the risk of spine injury is low. 80,81 Another recent study further suggests that patients with no history to suggest axial spine loading are at exceptionally low risk of cervical spine injury. 82 In patients without this specific traumatic mechanism, treatment maneuvers focused on restricting spine motion may distract rescuers from the critical role of oxygenation and ventilation.…”

Section: Cervical Spine Precautionsmentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update

Davis,

Schmidt,

Sempsrott

et al. 2024

Wilderness & Environmental Medicine

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The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.

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“…Most studies to date have investigated preventative medication discontinuation in older age groups, rather than explicitly in groups with complex health needs. Whilst there is an important association between age and complex health needs, older age groups are not homogenous, and modern clinical practitioners and policy-makers will increasingly need to take into account other key factors, such as the complex health needs we explore in this study, when making individual treatment decisions 34,35 .…”

Section: Research In Contextmentioning

confidence: 99%

Cardiovascular outcomes and fracture risk after the discontinuation of preventative medications in older patients with complex health needs: a self-controlled case series analysis

Prieto-Alhambra,

Dernie,

Delmestri

et al. 2024

Preprint

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Objective To assess the effect of stopping statins, antihypertensives, and bisphosphonates on the risk of cardiovascular events and fractures in older patients with complex health needs (CHN). Methods Patients aged >65 years, registered in CPRD GOLD for ≥1 year before study start (01/01/2010) and with CHN (non-elective hospitalisation/s, frailty or polypharmacy) were selected. Self-controlled case series (SCCS) analyses were subsequently conducted among people who did not use the respective preventative treatment in the year before study start. Incidence rate ratios (IRR) were calculated for myocardial infarction (MI) and stroke [antihypertensives, statins] and fractures [bisphosphonates] comparing event rates for the respective outcomes during treatment vs. post-discontinuation periods. Results 198,039 people were included to the CHN cohort. Among those, 6,245 individuals were included for the analysis of bisphosphonate discontinuation and fracture risk; 738 and 669 persons for the analysis of antihypertensive therapy discontinuation and MI/stroke risk; and 1,408 and 1,361 people for statin discontinuation and MI/stroke risk. Risk of MI was substantially increased following discontinuation of antihypertensives (IRR 2.6 [95%CI 1.56-4.33]) and statins (IRR 1.75 [1.16-2.62]). No significant association for treatment discontinuation and stroke risk was seen. Likewise, no increased fracture risk was seen after discontinuing bisphosphonates. However, discontinuation among people with >1 year history of bisphosphonate therapy pointed towards increased fracture risk. Conclusions Our study showed risks associated with discontinuing preventative medications in people with CHN, likely explained by the continued efficacy of these medications. Further research focussing on the risk-benefit of these treatments for most vulnerable older adults is needed.

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Improving clinical practice guidelines for older people: considerations and recommendations for more inclusive and ageing-relevant guidelines

Cited by 7 publications

References 8 publications

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update

Cardiovascular outcomes and fracture risk after the discontinuation of preventative medications in older patients with complex health needs: a self-controlled case series analysis

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