The results of the thesis of Christiaan Oudshoorn indicate that vitamin D deficiency is still prevalent among older individuals and that knowledge among older individuals about vitamin D is poor. With regard to functional performance an association between vitamin D status and muscle performance in both men and women was demonstrated. High dose vitamin D supplementation improves neuromuscular function (gait speed and TUGT performance) and is well tolerated. In addition associations were also observed with cognitive performance and vascular function.
The thesis is available on this website under research/thesis
Two randomized controlled trials (RCTs) towards optimization of pharmacotherapy in old patients, the SENATOR and OPERAM study, are well in progress. The SENATOR study have included about 200 patients and the OPERAM study will start the inclusion period on time in December. The RCTs use software supported methods, which include also the STOPP/START criteria. The aim of the studies is to avoid the prescription of inappropriate medicines and avoidable adverse drug reactions.
On behalf of the EUGMS Pharmacology Special Interest Group Perehudoff, Petrovic, O’Neill and Cherubini investigated geriatric medicine input in national regulatory medicine licensing agencies across Europe. A questionnaire was mailed to 22 national regulatory agencies in 2014. Currently only one agency (6%), i.e. the Swedish Medicines Authority, has a specific committee to evaluate medicines for older people, while previously, 2/21 agencies (10%) had a specific committee to assess medicines used by older people. The Swedish and Dutch regulatory agencies (13%) have binding policy on how to assess medicines for older people. On the other hand, nine national agencies (56%) follow external policies for the evaluation of geriatric medicines. Six agencies (38%) follow a policy concerning the inclusion of older people in clinical trials. Eight agencies (50%) have at least one geriatrician on their medical advisory boards, although this position is permanent at only three of them. Twelve agencies (75%) have access to ad-hoc geriatric advice. Compared to the previous survey, 6/21 agencies (28%) had a geriatrician on their medical advisory boards and 10/21 (48%) agencies provided for ad-hoc input of geriatricians into advisory board discussions. Finally, three regulatory authorities (19%), involve geriatricians in research on drug prescription in older people. This survey demonstrates that, despite some improvement from the previous investigation, there is still a need for promoting a greater involvement of geriatric expertise in medicines evaluation across Europe.
Th article is published in the Journal European Geriatric Medicine Doi : 10.1016/j.eurger.2016.07.003
The OPERAM study, towards optimization of polypharmacy with support of the STRIP method and the STRIPassistant, has finished the protocol and will start at the end of this year with the inclusion of the first patients. At the EUGMS a poster is presented of the adjudication of the ADR. The postar is available at this website at Abstracts and Posters
Esther van der Glind and co-authors have developed a method to calculate the time to benefit. They used statistical process control (SPC), a statistical method used for monitoring processes for quality control, to determine if and when the intervention group benefited significantly more than the control group. The open access article is published in Drugs and Aging 2016, 33:347–353. The article is available on this website (see Research/articles).
Ephor gives support to the “treatment as a lady” slogan. Especially the appropriate treatment of an old lady is of importance. Elderly women are using large amounts of medicines. They deserve to be included in trials to avoid the wrong dose and severe adverse effects after the authorization of the drug. This is also the case for elderly men. There is also a need for research in old men in diseases common in women as osteoporosis. Personalized medicine is of importance, however don’t forget to avoid harm in old persons.
High-dose vitamin D supplementation does not improve lower-extremity function and increases the risk for falls among elderly adults. This is the result of a randomized clinical trial of 200 men and women aged 70 or older who had experienced at least one low-trauma fall in the prior year. Two high vitamin D doses monthly were compared with a standard dose of 24,000 IU of vitamin D3 per month (equivalent to the currently recommended 800 IU per day). Subjects taking the higher doses showed no improvements in lower-extremity function and were more likely to have a second fall (P = .048) in the subsequent year.
The study is published online January 4 in JAMA Internal Medicine by Heike A Bischoff-Ferrari, from the University Hospital of Zurich, Switzerland, and colleagues.
In a randomized controlled trial, towards computerized medication reviews with the STRIP-assistant, the authors hypothesize that having a group of users perform a similar task over a prolonged period of time will lead to improvements in efficiency of that task. Three expert teams, consisting of an independent physician and an independent pharmacist, conducted 150 computerized medication reviews on patients in 13 general practices located in Amsterdam, the Netherlands. The average time in minutes required to conduct medication reviews up to the first quartile was 20 minutes (SD = 9.00), while the time from the third quartile up was 10 minutes (SD = 6.13). This leads the authors to conclude that the amount of time users needed to perform similar tasks decreased significantly as they gained experience over time. The article is available at this website (see Research/Articles).
A Dutch research-group studied the association between inappropriate prescribing and hospital admissions as a nested case-control study of the HARM study. They concluded that patients with potentially inappropriate prescribing, detected with the STOPP & START 2008 criteria, are at risk of preventable medication-related hospital admissions. The STOPP & START 2008 criteria can be used to identify older people at risk of medication-related problems. The study is published in Drug Safety January 2016, Volume 39, Issue 1, pp 79-87.
Michiel Meulendijk has defended successfully his thesis “Optimazing medication reviews through decision support: prescribing a better pill to swallow.” In his thesis he describes studies towards the STRIPassistant, a digital tool. The STRIPassistant will be improved and studied in the OPERAM study a RCT performed in Europe. The thesis is available at this website.