Insomnia in older adults

Molnar, Frank; Frank, Chris; Chun, Soojin; Lee, Elliott Kyung

doi:10.46747/cfp.670125

Cited by 28 publications

(28 citation statements)

References 9 publications

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“…The panel agreed that an investigation into the cause of iron deficiency should be performed, including colorectal cancer screening, if ferritin levels are below 50 μg/L. This is in line with published guidelines and reflects the increased incidence of gastrointestinal cancers with advancing age 39 …”

Section: Discussionsupporting

confidence: 56%

Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study

Naveed

Goldberg

Shore

et al. 2023

Int J Lab Hematology

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Background Iron deficiency is highly prevalent worldwide and is an issue of health inequity. Despite its high prevalence, uncertainty on the clinical applicability and evidence‐base of iron‐related lab test cut‐offs remains. In particular, current ferritin decision limits for the diagnosis of iron deficiency may not be clinically appropriate nor scientifically grounded. Methods A modified Delphi study was conducted with various clinical experts who manage iron deficiency across Canada. Statements about ferritin decision limits were generated by a steering committee, then distributed to the expert panel to vote on agreement with the aim of achieving consensus and acquiring feedback on the presented statements. Consensus was reached after two rounds, which was defined as 70% of experts rating their agreement for a statement as 5 or higher on a Likert scale from 1 to 7. Results Twenty‐six clinical experts across 10 different specialties took part in the study. Consensus was achieved on 28 ferritin decision limit statements in various populations (including patients with multiple comorbid conditions, pediatric patients, and pregnant patients). For example, there was consensus that a ferritin <30 μg/L rules in iron deficiency in all adult patients (age ≥ 18 years) and warrants iron replacement therapy. Conclusion Consensus statements generated through this study corresponded with current evidence‐based literature and guidelines. These statements provide clarity to facilitate clinical decisions around the appropriate detection and management of iron deficiency.

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Section: Discussionsupporting

confidence: 56%

Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study

Naveed

Goldberg

Shore

et al. 2023

Int J Lab Hematology

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“…First, although we used the cutoff value of 110 g/L for pretreatment Hb count solely accordingly to the NCCN guideline, we do acknowledge that the definition of normal Hb count may vary subtly with factors including age and sex according to the World Health Organization. 41,42 Second, only patients receiving more than 6 weeks of ICI treatment were included in this study, which might introduce unknown selection bias. Third, we did not explore the correlation between the change of Hb count and ICI benefits during the treatment.…”

Section: Discussionmentioning

confidence: 99%

Pretreatment hemoglobin level as a predictor to evaluate the efficacy of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer

Zhang

Fang

et al. 2020

Ther Adv Med Oncol

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Background: Targeting immune checkpoints represents an immense breakthrough in cancer therapeutics. The prognostic value of hemoglobin (Hb) has been investigated in many malignancies including non-small cell lung cancer (NSCLC). However, the prognostic impact of pretreatment Hb count for immune checkpoint inhibitors (ICIs) in advanced NSCLC patients remains unclear. Methods: A total of 310 late-stage NSCLC patients who received ICI therapies between January 2015 and March 2019 were prospectively enrolled. We used a propensity score-matched cohort analysis for this study. Patients’ clinicopathological characteristics and pretreatment Hb concentration were assessed against the progression-free survival (PFS) and overall survival (OS) using the Kaplan–Meier method and Cox proportional hazards regression. Results: A propensity score (PS)-matched cohort analysis was applied to adjust for potential bias and to create two comparable groups according to patients’ clinicopathological characteristics. The patients with normal baseline Hb levels (⩾110 g/L) had significantly longer PFS [median: 10.0 versus 4.0 months, hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.46−0.86; p = 0.001] and OS [median: 17.6 versus 10.5 months, HR (95% CI): 0.56 (0.40−0.79); p < 0.001] than those with decreased Hb count (<110 g/L) in a PS-matched cohort ( n = 255). For patients with normal pretreatment Hb levels, ICI combination therapy was significantly associated with better PFS [median: 11.1 versus 8.0 months, HR (95% CI): 0.74 (0.50−1.06); p = 0.09] and OS [median: 26.0 versus 12.9 months, HR (95% CI): 0.56 (0.37−0.86); p = 0.008] than monotherapy, but there was no such trend for patients with decreased baseline Hb levels. Conclusion: Our findings showed that normal pretreatment Hb count served as a favorable prognostic marker in advanced NSCLC patients treated with ICIs, representing an economical biomarker with readily measuring performance among all reported ones.

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“… 24 As anemia is a common condition in adults aged 60 years and older, and given the demographic growth of this population and the morbidity and mortality associated with anemia, primary care physicians should be familiar with the evaluation and management of anemia in older people. 25 …”

Section: Discussionmentioning

confidence: 99%

Morbidity profile among older people at primary health care centers in Saudi Arabia during the period 2012-2020

Al-Amoud

Omar

Almashjary

et al. 2023

SMJ

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Objectives: To evaluate the morbidity profile and explore the geriatric giants, health problems, and their risk factors among old people in the older people health clinics at primary health care centers )PHCCs( in Saudi Arabia.Methods: This is a record-based descriptive crosssectional study. Data was collected between 2012-2020 using the health data of older people to whom comprehensive geriatric assessment )CGA( was carried out at 1,481 PHCCs in Saudi Arabia. Data included sociodemographic and health related characteristics, medications, results of CGA, complete clinical examination, and laboratory results.

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Insomnia in older adults

Abstract: How can I best manage insomnia in older patients?This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.

Cited by 28 publications

References 9 publications

Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study

Defining ferritin clinical decision limits to improve diagnosis and treatment of iron deficiency: A modified Delphi study

Pretreatment hemoglobin level as a predictor to evaluate the efficacy of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer

Morbidity profile among older people at primary health care centers in Saudi Arabia during the period 2012-2020

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