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Pruntel SM, van Munster BC, de Vries JJ, Vissink A, Visser A. Oral Health as a Risk Factor for Alzheimer Disease. J Prev Alzheimers Dis 2024; 11:249-258. [PMID: 38230738 PMCID: PMC10994994 DOI: 10.14283/jpad.2023.82] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 01/18/2024]
Abstract
In patients with Alzheimer's disease pathophysiological changes of the brain that initiate the onset of Alzheimer's disease include accumulation of amyloid-β plaques and phosphorylation of tau-tangles. A rather recently considered risk factor for the onset of Alzheimer's disease is poor oral health. The aim of this systematic review of the literature was to assess the potential association(s) of oral health as a risk factor for the onset of Alzheimer's disease. After a systematic search of Pubmed, Embase and Web of Science. A total of 1962 studies were assessed, of which 17 studies demonstrated possible associations between oral health diseases and Alzheimer's disease. 4 theories could be distinguished that describe the possible links between oral health and the development or onset of Alzheimer's disease; 1) role of pathogens, 2) role of inflammatory mediators, 3) role of APOE alleles and 4) role of Aβ peptide. The main common denominator of all the theories is the neuroinflammation due to poor oral health. Yet, there is insufficient evidence to prove a link due to the diversity of the designs used and the quality of the study design of the included studies. Therefore, further research is needed to find causal links between oral health and neuroinflammation that possibly can lead to the onset of Alzheimer's disease with the future intention to prevent cognitive decline by better dental care.
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Affiliation(s)
- S M Pruntel
- Anita Visser, Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Antonius Deusinglaan 1, Groningen, Groningen, 9713 AV, The Netherlands, Tel: 050 361 3840, E-mail:
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2
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Bernabeu-Wittel M, Para O, Voicehovska J, Gómez-Huelgas R, Václavík J, Battegay E, Holecki M, van Munster BC. Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med 2023; 109:97-106. [PMID: 36653235 DOI: 10.1016/j.ejim.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Patients with multimorbidity increasingly impact healthcare systems, both in primary care and in hospitals. This is particularly true in Internal Medicine. This population associates with higher mortality rates, polypharmacy, hospital readmissions, post-discharge syndrome, anxiety, depression, accelerated age-related functional decline, and development of geriatric syndromes, amongst others. Internists and Hospitalists, in one of their roles as Generalists, are increasingly asked to attend to these patients, both in their own Departments as well as in surgical areas. The management of polypathology and multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience. In addition, patients' needs, health-care environment, and routines have changed, so emerging and re-emerging specific competences and approaches are required to offer the best coordinated, continuous, and comprehensive integrated care to these populations, to achieve optimal health outcomes and satisfaction of patients, their relatives, and staff. This position paper proposes a set of emerging and re-emerging competences for internal medicine specialists, which are needed to optimally address multimorbidity now and in the future.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Medicine, Internal Medicine Department. Hospital Universitario Virgen del Rocío, University of Sevilla, Spain
| | - O Para
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - J Voicehovska
- Internal Diseases Department, Nephrology and Renal replacement therapy clinics, Riga Stradins University, Riga East University hospital, Riga, Latvia
| | - R Gómez-Huelgas
- Internal Medicine Department. Department of Medicine, Hospital Universitario Regional de Málaga, University of Málaga, Spain
| | - J Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Ostrava University Faculty of Medicine, Ostrava, Czech Republic
| | - E Battegay
- International Center for Multimorbidity and Complexity (ICMC), University of Zurich, Zurich, University Hospital Basel (Department of Psychosomatic Medicine) and Merian Iselin Klinik Basel. Switzerland
| | - M Holecki
- Department of Internal, Autoimmune and Metabolic Diseases. Medical University of Silesia, Katowice. Poland
| | - B C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Roldan Munoz S, de Vries ST, Lankester G, Pignatti F, van Munster BC, Radford I, Guizzaro L, Mol PGM, Hillege H, Postmus D. Preferences about Future Alzheimer's Disease Treatments Elicited through an Online Survey Using the Threshold Technique. J Prev Alzheimers Dis 2023; 10:756-764. [PMID: 37874097 DOI: 10.14283/jpad.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND Treatments aiming at slowing down the progression of Alzheimer's disease (AD) may soon become available. However, information about the risks that people are willing to accept in order to delay the progression of the disease is limited. OBJECTIVE To determine the trade-offs that individuals are willing to make between the benefits and risks of hypothetical treatments for AD, and the extent to which these trade-offs depend on individuals' characteristics and beliefs about medicines. DESIGN Online, cross-sectional survey study. SETTING Population in the UK. Public link to the survey available at the websites of Alzheimer's Research UK and Join Dementia Research. PARTICIPANTS Everyone self-reported ≥18 years old was eligible to participate. A total of 4384 people entered the survey and 3658 completed it. MEASUREMENTS The maximum acceptable risks (MARs) of participants for moderate and severe adverse events in exchange for a 2-year delay in disease progression. The risks were expressed on ordinal scales, from <10% to ≥50%, above a pre-existing risk of 30% for moderate adverse events and 10% for severe adverse events. We obtained the population median MARs using log-normal survival models and quantified the effects of individuals' characteristics and beliefs about medicines in terms of acceleration factors. RESULTS For the moderate adverse events, 26% of the participants had a MAR ≥50%, followed by 25% of the participants with a MAR of 10 to <20%, giving an estimated median MAR of 25.4% (95% confidence interval [CI] 24.5 to 26.3). For the severe adverse events, 43% of the participants had a MAR <10%, followed by 25% of the participants with a MAR of 10 to <20%, resulting in an estimated median MAR of 12.1% (95%CI 11.6 to 12.5). Factors that were associated with the individuals' MARs for one or both adverse events were age, gender, educational level, living alone, and beliefs about medicines. Whether or not individuals were living with memory problems or had experience as a caregiver had no effect on the MARs for any of the adverse events. CONCLUSION Trade-offs between benefits and risks of AD treatments are heterogeneous and influenced by individuals' characteristics and beliefs about medicines. This heterogeneity should be acknowledged during the medicinal product decision-making in order to fulfil the needs of the various subpopulations.
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Affiliation(s)
- S Roldan Munoz
- Sonia Roldan Munoz, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology. Hanzeplein 1, 9713 GZ Groningen; Building 50, entrance 45, 1st floor, Room 50.1.C.003. Department zip code AP50, mailbox 30.001. 9700 RB Groningen,
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Oud FMM, Schut MC, Spies PE, van der Zaag-Loonen HJ, de Rooij SE, Abu-Hanna A, van Munster BC. Interaction between geriatric syndromes in predicting three months mortality risk. Arch Gerontol Geriatr 2022; 103:104774. [PMID: 35849976 DOI: 10.1016/j.archger.2022.104774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/03/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Capturing frailty using a quick tool has proven to be challenging. We hypothesise that this is due to the complex interactions between frailty domains. We aimed to identify these interactions and assess whether adding interactions between domains improves mortality predictability. METHODS In this retrospective cohort study, we selected all patients aged 70 or older who were admitted to one Dutch hospital between April 2015 and April 2016. Patient characteristics, frailty screening (using VMS (Safety Management System), a screening tool used in Dutch hospital care), length of stay, and mortality within three months were retrospectively collected from electronic medical records. To identify predictive interactions between the frailty domains, we constructed a classification tree with mortality as the outcome using five variables: the four VMS-domains (delirium risk, fall risk, malnutrition, physical impairment) and their sum. To determine if any domain interactions were predictive for three-month mortality, we performed a multivariable logistic regression analysis. RESULTS We included 4,478 patients. (median age: 79 years; maximum age: 101 years; 44.8% male) The highest risk for three-month mortality included patients that were physically impaired and malnourished (23% (95%-CI 19.0-27.4%)). Subgroups had comparable three-month mortality risks based on different domains: malnutrition without physical impairment (15.2% (96%-CI 12.4-18.6%)) and physical impairment and delirium risk without malnutrition (16.3% (95%-CI 13.7-19.2%)). DISCUSSION We showed that taking interactions between domains into account improves the predictability of three-month mortality risk. Therefore, when screening for frailty, simply adding up domains with a cut-off score results in loss of valuable information.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands; Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands.
| | - M C Schut
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - P E Spies
- Department of Geriatrics and Centre of Excellence for Old Age Medicine, Gelre Ziekenhuizen Apeldoorn and Zutphen, the Netherlands
| | - H J van der Zaag-Loonen
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - S E de Rooij
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands; Amstelland Hospital, Amstelveen, the Netherlands
| | - A Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - B C van Munster
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, the Netherlands
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Argillander TE, Schäfer S, van Westreenen HL, Kamper A, van der Zaag-Loonen HJ, van Duijvendijk P, van Munster BC. The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer. J Geriatr Oncol 2022; 13:888-891. [PMID: 35339404 DOI: 10.1016/j.jgo.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands.
| | - S Schäfer
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - A Kamper
- Department of Geriatrics, Isala Hospital, Zwolle, the Netherlands
| | - H J van der Zaag-Loonen
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
| | | | - B C van Munster
- University of Groningen, University Medical Center Groningen, University Center of Geriatric Medicine, Groningen, the Netherlands
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Douairi J, Bos EGT, van Munster BC, Boudestein K, Benraad C, Disselhorst L, Oude Voshaar RC, Oud FMM, Kok RM. Risk of Four Geriatric Syndromes: A Comparison of Mental Health Care and General Hospital Inpatients. J Frailty Aging 2022; 12:59-62. [PMID: 36629085 DOI: 10.14283/jfa.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
An observational, cross-sectional study is conducted to compare elevated risk scores of four geriatric syndromes (falls, malnutrition, physical impairment, delirium) in older hospitalized psychiatric patients (n=178) with patients hospitalized in a general hospital (n=687). The median age of all patients was 78 years (IQR 73.3-83.3), 53% were female. After correction for age and gender, we found significantly more often an elevated risk in the mental health care group, compared to the general hospital group of falls (Odds Ratio (OR) = 1.75; 95% Confidence Interval (CI) 1.18-2.57), malnutrition (OR = 4.12; 95% CI 2.67-6.36) and delirium (OR = 6.45; 95% CI 4.23-9.85). The risk on physical impairment was not statistically significantly different in both groups (OR = 1.36; 95% CI .90-2.07). Older mental health care patients have a higher risk to develop geriatric syndromes compared to general hospital patients with the same age and gender, which might be explained by a higher level of frailty.
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Affiliation(s)
- J Douairi
- Jamila Douairi, MSc, Parnassia Groep, Mental Health Care Institute, Mangostraat 1, PO Box 2552 KS, The Hague, The Netherlands, telephone number 0031-88-3575252, fax number 0031-88-3584168, E-mail:
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7
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Argillander TE, Heil TC, Melis RJF, van Duijvendijk P, Klaase JM, van Munster BC. Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: A systematic review. Eur J Surg Oncol 2021; 48:570-581. [PMID: 34629224 DOI: 10.1016/j.ejso.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/02/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Abdominal cancer surgery is associated with considerable morbidity in older patients. Assessment of preoperative physical status is therefore essential. The aim of this review was to describe and compare the objective physical tests that are currently used in abdominal cancer surgery in the older patient population with regard to postoperative outcomes. METHODS Medline, Embase, CINAHL and Web of Science were searched until 31 December 2020. Non-interventional cohort studies were eligible if they included patients ≥65 years undergoing abdominal cancer surgery, reported results on objective preoperative physical assessment such as Cardiopulmonary Exercise Testing (CPET), field walk tests or muscle strength, and on postoperative outcomes. RESULTS 23 publications were included (10 CPET, 13 non-CPET including Timed Up & Go, grip strength, 6-minute walking test (6MWT) and incremental shuttle walk test (ISWT)). Meta-analysis was precluded due to heterogeneity between study cohorts, different cut-off points, and inconsistent reporting of outcomes. In CPET studies, ventilatory anaerobic threshold and minute ventilation/carbon dioxide production gradient were associated with adverse outcomes. ISWT and 6MWT predicted outcomes in two studies. Tests addressing muscle strength and function were of limited value. No study compared different physical tests. DISCUSSION CPET has the ability to predict adverse postoperative outcomes, but it is time-consuming and requires expert assessment. ISWT or 6MWT might be a feasible alternative to estimate aerobic capacity. Muscle strength and function tests currently have limited value in risk prediction. Future research should compare the predictive value of different physical instruments with regard to postoperative outcomes in older surgical patients.
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Affiliation(s)
- T E Argillander
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands; Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, the Netherlands; University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - T C Heil
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - J M Klaase
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Festen S, Nijmeijer H, van Leeuwen BL, van Etten B, van Munster BC, de Graeff P. Multidisciplinary decision-making in older patients with cancer, does it differ from younger patients? Eur J Surg Oncol 2021; 47:2682-2688. [PMID: 34127326 DOI: 10.1016/j.ejso.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In order to tailor treatment to the individual patient, it is important to take the patients context and preferences into account, especially for older patients. We assessed the quality of information used in the decision-making process in different oncological MDTs and compared this for older (≥70 years) and younger patients. PATIENTS AND METHODS Cross-sectional observations of oncological MDTs were performed, using an observation tool in a University Hospital. Primary outcome measures were quality of input of information into the discussion for older and younger patients. Secondary outcomes were the contribution of different team members, discussion time for each case and whether or not a treatment decision was formulated. RESULTS Five-hundred and three cases were observed. The median patient age was 63 year, 32% were ≥70. In both age groups quality of patient-centered information (psychosocial information and patient's view) was poor. There was no difference in quality of information between older and younger patients, only for comorbidities the quality of information for older patients was better. There was no significant difference in the contributions by team members, discussion time (median 3.54 min) or number of decision reached (87.5%). CONCLUSION For both age groups, we observed a lack of patient-centered information. The only difference between the age groups was for information on comorbidities. There were also no differences in contributions by different team members, case discussion time or number of decisions. Decision-making in the observed oncological MDTs was mostly based on medical technical information.
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Affiliation(s)
- S Festen
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - H Nijmeijer
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B van Etten
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B C van Munster
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - P de Graeff
- University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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de Boer SE, Sanders JSF, Bemelman FJ, Betjes MGH, Burgerhof JGM, Hilbrands L, Kuypers D, van Munster BC, Nurmohamed SA, de Vries APJ, van Zuilen AD, Hesselink DA, Berger SP. Rationale and design of the OPTIMIZE trial: OPen label multicenter randomized trial comparing standard IMmunosuppression with tacrolimus and mycophenolate mofetil with a low exposure tacrolimus regimen In combination with everolimus in de novo renal transplantation in Elderly patients. BMC Nephrol 2021; 22:208. [PMID: 34078323 PMCID: PMC8172178 DOI: 10.1186/s12882-021-02409-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In 2019, more than 30 % of all newly transplanted kidney transplant recipients in The Netherlands were above 65 years of age. Elderly patients are less prone to rejection, and death censored graft loss is less frequent compared to younger recipients. Elderly recipients do have increased rates of malignancy and infection-related mortality. Poor kidney transplant function in elderly recipients may be related to both pre-existing (i.e. donor-derived) kidney damage and increased susceptibility to nephrotoxicity of calcineurin inhibitors (CNIs) in kidneys from older donors. Hence, it is pivotal to shift the focus from prevention of rejection to preservation of graft function and prevention of over-immunosuppression in the elderly. The OPTIMIZE study will test the hypothesis that reduced CNI exposure in combination with everolimus will lead to better kidney transplant function, a reduced incidence of complications and improved health-related quality of life for kidney transplant recipients aged 65 years and older, compared to standard immunosuppression. METHODS This open label, randomized, multicenter clinical trial will include 374 elderly kidney transplant recipients (≥ 65 years) and consists of two strata. Stratum A includes elderly recipients of a kidney from an elderly deceased donor and stratum B includes elderly recipients of a kidney from a living donor or from a deceased donor < 65 years. In each stratum, subjects will be randomized to a standard, tacrolimus-based immunosuppressive regimen with mycophenolate mofetil and glucocorticoids or an adapted immunosuppressive regimen with reduced CNI exposure in combination with everolimus and glucocorticoids. The primary endpoint is 'successful transplantation', defined as survival with a functioning graft and an eGFR ≥ 30 ml/min per 1.73 m2 in stratum A and ≥ 45 ml/min per 1.73 m2 in stratum B, after 2 years, respectively. CONCLUSIONS The OPTIMIZE study will help to determine the optimal immunosuppressive regimen after kidney transplantation for elderly patients and the cost-effectiveness of this regimen. It will also provide deeper insight into immunosenescence and both subjective and objective outcomes after kidney transplantation in elderly recipients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03797196 , registered January 9th, 2019. EudraCT: 2018-003194-10, registered March 19th, 2019.
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Affiliation(s)
- S E de Boer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J S F Sanders
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F J Bemelman
- Department of Internal Medicine, Division of Nephrology, Amsterdam Universal Medical Center, Amsterdam, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J G M Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Hilbrands
- Department of Internal Medicine, Division of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - B C van Munster
- Department of Internal Medicine, Divison of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S A Nurmohamed
- Department of Internal Medicine, Division of Nephrology, Amsterdam Universal Medical Center, Amsterdam, The Netherlands
| | - A P J de Vries
- Department of Internal Medicine, Division of Nephrology; and Leiden Transplant Center, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - A D van Zuilen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D A Hesselink
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Oud FMM, Spies PE, Braam RL, van Munster BC. Recognition of cognitive impairment and depressive symptoms in older patients with heart failure. Neth Heart J 2020; 29:377-382. [PMID: 33320302 PMCID: PMC8271051 DOI: 10.1007/s12471-020-01527-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cognitive impairment and depression in patients with heart failure (HF) are common comorbidities and are associated with increased morbidity, readmissions and mortality. Timely recognition of cognitive impairment and depression is important for providing optimal care. The aim of our study was to determine if these disorders were recognised by clinicians and, secondly, if they were associated with hospital admissions and mortality within 6 months' follow-up. METHODS Patients (aged ≥65 years) diagnosed with HF were included from the cardiology outpatient clinic of Gelre Hospitals. Cognitive status was evaluated with the Montreal Cognitive Assessment test (score ≤22). Depressive symptoms were assessed with the Geriatric Depression Scale (score >5). Patient characteristics were collected from electronic patient files. The clinician was blinded to the tests and asked to assess cognitive status and mood. RESULTS We included 157 patients. Their median age was 79 years (65-92); 98 (62%) were male. The majority had New York Heart Association functional class II. Cognitive impairment was present in 56 (36%) patients. Depressive symptoms were present in 21 (13%) patients. In 27 of 56 patients (48%) cognitive impairment was not recognised by clinicians. Depressive symptoms were not recognised in 11 of 21 patients (52%). During 6 months' follow-up 24 (15%) patients were readmitted for HF-related reasons and 18 (11%) patients died. There was no difference in readmission and mortality rate between patients with or without cognitive impairment and patients with or without depressive symptoms. CONCLUSION Cognitive impairment and depressive symptoms were infrequently recognised during outpatient clinic visits.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands. .,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
| | - P E Spies
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - R L Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - B C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Stoffels JMJ, van Munster BC, Muller M. [Delirium in the elderly; article for education and training purposes]. Ned Tijdschr Geneeskd 2020; 164:D4953. [PMID: 33332054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In delirium, there is an acute change of consciousness with fluctuations in attention, cognition and perception. Delirium can be provoked by medical conditions, or the use or withdrawal of drugs. Risk factors include older age and cognitive impairment. Delirium is associated with many complications, represents a significant emotional burden for the patient and caretakers, increases length of stay in the hospital, and causes higher health care costs. Non-pharmacological measurements can sometimes prevent delirium, and are essential for its treatment with proven effectiveness. Antipsychotics should be administered only as an exception, not as a rule. Antipsychotics may be of use when the patient puts himself or others in danger, or when he suffers substantially from hallucinations.
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Affiliation(s)
- J M J Stoffels
- Amsterdam UMC, locatie VUmc, afd. Interne-ouderengeneeskunde, Amsterdam
- Contact: J.M.J. Stoffels
| | - B C van Munster
- UMCG, afd. Interne Geneeskunde-Ouderengeneeskunde, Groningen
| | - M Muller
- Amsterdam UMC, locatie VUmc, afd. Interne-ouderengeneeskunde, Amsterdam
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Schuijt HJ, Oud FMM, Bruns EJR, van Duijvendijk P, Van der Zaag-Loonen HJ, Spies PE, van Munster BC. Does the Dutch Safety Management Program predict adverse outcomes for older patients in the emergency department? Neth J Med 2020; 78:244-250. [PMID: 33093249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Frailty screening in the emergency department may identify frail patients at risk for adverse outcomes. This study investigated if the Dutch Safety Management Program (VMS) screener predicts outcomes in older patients in the emergency department. METHODS In this prospective cohort study, patients aged 70 years or older presenting to the emergency department were recruited on workdays between 10:00 AM and 7:00 PM from May 2017 until August 2017. Patients were screened in four domains: activities of daily living, malnutrition, risk of delirium, and risk of falling. After 90 days of follow up, mortality, functional decline, living situation, falls, readmission to the emergency department, and readmission to the hospital were recorded. VMS was studied using the total VMS score as a predictor with ROC curve analysis, and using a cut-off point to divide patients into frail and non-frail groups to calculate positive predictive value (PPV) and negative predictive value (NPV). RESULTS A total of 249 patients were included. Higher VMS score was associated with 90-day mortality (AUC 0.65, 95% CI 0.54-0.76) and falling (AUC 0.67, 95% CI 0.56-0.78). VMS frailty predicted mortality (PPV 0.15, NPV 0.94, p = 0.05) and falling (PPV 0.22, NPV 0.92, p = 0.02), but none of the other outcomes. CONCLUSION In this selected group of patients, higher VMS score was associated with 90-day mortality and falls. The low positive predictive value shows that the VMS screener is unsuitable for identifying high-risk patients in the ED. The high negative predictive value indicates that the screener can identify patients not at risk for adverse medical outcomes. This could be useful to determine which patients should undergo additional screening.
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Affiliation(s)
- H-J Schuijt
- Centre of Excellence for Old Age Medicine, Gelre Hospitals, Apeldoorn and Zutphen, the Netherlands, Department of Surgery, University Medical Centre Utrecht, the Netherlands, Department of Surgery, Gelre Hospitals, Apeldoorn and Zutphen, the Netherlands
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Verhoeff M, Meijer-Smit OM, de Rooij SEJA, van Munster BC. Multiple chronic conditions: the need for integrated secondary care. Neth J Med 2019; 77:220-223. [PMID: 31391328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Current hospital-level care is "mostly disease-specific and monodisciplinary-oriented". These three case reports show different journeys that patients with multiple chronic conditions experienced in Dutch secondary outpatient care, and aim to demonstrate why an integrated care approach might be beneficial for this group of patients.
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Affiliation(s)
- M Verhoeff
- Department of Internal Medicine/Geriatrics, University Centre of Geriatric Medicine, University Medical Centre of Groningen, Groningen, the Netherlands
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Verhoeff M, van der Zaag HJ, Vermeeren Y, van Munster BC. Secondary care experiences of patients with multiple chronic conditions. Neth J Med 2018; 76:397-406. [PMID: 30465654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study aimed to investigate patients' experiences, beliefs and understandings of the current secondary care of patients with multiple chronic conditions (MCC) in the Netherlands. METHODS A qualitative, interpretative description design was used. We conducted semi-structured, in-depth interviews with patients with MCC, who visited at least two physicians in Gelre Hospitals for at least two appointments in the previous year. After eight interviews data saturation was achieved. RESULTS Being a patient with MCC in the hospital can be complex and keeping an overview required effort, according to the participants. Most participants would appreciate more coordination and communication. However, the exact needs seemed to differ. The multiple visits transformed them into experienced patients: based on their experiences and observations they developed strategies to sustain themselves in the hospital. Different types of communication (an important, overarching theme) evoked specific feelings and expectations that were important for the patients' care experiences as well. CONCLUSION An overview of patient care seems an essential element for a more coordinated, individualised approach to care. Future research might focus on ways to engage both healthcare professionals and patients in the improvement of care. It could aim to find ways to create an overview and coordination, and define responsibilities, but also to clarify which groups of patients need assistance. It might also investigate the effect of good and clear communication on reducing obstacles that patients perceive when dealing with healthcare situations. Overall, also in the future, patients' care experiences could play an important role in determining the direction of new interventions.
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Affiliation(s)
- M Verhoeff
- Departments of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
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15
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Du Puy RS, Postmus I, Stott DJ, Blum MR, Poortvliet RKE, Den Elzen WPJ, Peeters RP, van Munster BC, Wolffenbuttel BHR, Westendorp RGJ, Kearney PM, Ford I, Kean S, Messow CM, Watt T, Jukema JW, Dekkers OM, Smit JWA, Rodondi N, Gussekloo J, Mooijaart SP. Study protocol: a randomised controlled trial on the clinical effects of levothyroxine treatment for subclinical hypothyroidism in people aged 80 years and over. BMC Endocr Disord 2018; 18:67. [PMID: 30231866 PMCID: PMC6146605 DOI: 10.1186/s12902-018-0285-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/03/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Subclinical hypothyroidism is common in older people and its contribution to health and disease needs to be elucidated further. Observational and clinical trial data on the clinical effects of subclinical hypothyroidism in persons aged 80 years and over is inconclusive, with some studies suggesting harm and some suggesting benefits, translating into equipoise whether levothyroxine therapy provides clinical benefits. This manuscript describes the study protocol for the Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial to generate the necessary evidence base. METHODS The IEMO 80-plus thyroid trial was explicitly designed as an ancillary experiment to the Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism randomised placebo controlled Trial (TRUST) with a near identical protocol and shared research infrastructure. Outcomes will be presented separately for the IEMO and TRUST 80-plus groups, as well as a pre-planned combined analysis of the 145 participants included in the IEMO trial and the 146 participants from the TRUST thyroid trial aged 80 years and over. The IEMO 80-plus thyroid trial is a multi-centre randomised double-blind placebo-controlled parallel group trial of levothyroxine treatment in community-dwelling participants aged 80 years and over with persistent subclinical hypothyroidism (TSH ≥4.6 and ≤ 19.9 mU/L and fT4 within laboratory reference ranges). Participants are randomised to levothyroxine 25 or 50 micrograms daily or matching placebo with dose titrations according to TSH levels, for a minimum follow-up of one and a maximum of three years. Primary study endpoints: hypothyroid physical symptoms and tiredness on the thyroid-related quality of life patient-reported outcome (ThyPRO) at one year. Secondary endpoints: generic quality of life, executive cognitive function, handgrip strength, functional ability, blood pressure, weight, body mass index, and mortality. Adverse events will be recorded with specific interest on cardiovascular endpoints such as atrial fibrillation and heart failure. DISCUSSION The combined analysis of participants in the IEMO 80-plus thyroid trial with the participants aged over 80 in the TRUST trial will provide the largest experimental evidence base on multimodal effects of levothyroxine treatment in 80-plus persons to date. TRIAL REGISTRATION Nederlands (Dutch) Trial Register: NTR3851 (12-02-2013), EudraCT: 2012-004160-22 (17-02-2013), ABR-41259.058.13 (12-02-2013).
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Affiliation(s)
- R. S. Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - I. Postmus
- Department of Gerontology and Geriatrics (C7-Q), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
- Institute for Evidence-based Medicine in Old age, Leiden, the Netherlands
| | - D. J. Stott
- Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M. R. Blum
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R. K. E. Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - W. P. J. Den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - R. P. Peeters
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - B. C. van Munster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - B. H. R. Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R. G. J. Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - P. M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - I. Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - S. Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - C. M. Messow
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - T. Watt
- Department of Internal Medicine, Copenhagen University Hospital Herlev, Gentofte, Denmark
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - O. M. Dekkers
- Department of Endocrinology and metabolic disorders, Leiden University Medical Center, Leiden, the Netherlands
| | - J. W. A. Smit
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - N. Rodondi
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - J. Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Gerontology and Geriatrics (C7-Q), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - S. P. Mooijaart
- Department of Gerontology and Geriatrics (C7-Q), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
- Institute for Evidence-based Medicine in Old age, Leiden, the Netherlands
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Bruns ERJ, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, van der Zaag ES, Bemelman WA, van Munster BC. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis 2016; 18:O267-77. [PMID: 27332897 DOI: 10.1111/codi.13429] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
AIM Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery. METHOD Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed. RESULTS Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis. CONCLUSION Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment.
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Affiliation(s)
- E R J Bruns
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - B van den Heuvel
- Department of Surgery, VU Medical Centre, Amsterdam, the Netherlands
| | - C J Buskens
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
| | | | - S Festen
- Department of Medicine, University Medical Centre, Groningen, the Netherlands
| | - E B Wassenaar
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - E S van der Zaag
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - W A Bemelman
- Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands
| | - B C van Munster
- Department of Medicine, University Medical Centre, Groningen, the Netherlands.,Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
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Hamaker ME, Schulkes KJ, Ten Bokkel Huinink D, van Munster BC, van Huis LH, van den Bos F. Evaluation and reporting of quality of life outcomes in phase III chemotherapy trials for poor prognosis malignancies. Qual Life Res 2016; 26:65-71. [PMID: 27381254 DOI: 10.1007/s11136-016-1360-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Quality of life (QoL) should be included in trials where treatment is expected to have a limited impact on long-term survival. We set out to determine whether phase III chemotherapy trials addressing solid malignancies with a poor prognosis include QoL as a study objective and to assess the extent to which these data have been published. METHODS We performed a search of the National Institutes of Health clinical trial registry website to identify phase III chemotherapy trials for poor prognosis solid malignancies. The retrieved protocols were subsequently reviewed, to assess whether QoL was included as an outcome measure. Subsequently, a Medline, Embase and world-wide-web search was performed to identify any full text publication or conference abstract regarding the outcome of trials including QoL, which were then reviewed to determine whether and to what extend quality of life results were included. RESULTS For the 201 included studies, we found that 57 % of trials did not include QoL as a study objective. Of the remaining trials, 50 % have not reported the QoL results in a full text publication, or presented these only as a single sentence statement. CONCLUSION Evaluation and publication of QoL results of phase III chemotherapy trials for poor prognosis solid malignancies remains limited. This must be improved in order to provide patients suffering from these malignancies with adequate information regarding the benefits and risks of the treatment in terms of both prolongation and quality of life.
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Affiliation(s)
- M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/Zeist/Doorn, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
| | - K J Schulkes
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | | | - B C van Munster
- Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
- Department of Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - L H van Huis
- Department of Oncology, Diakonessenhuis, Utrecht, Utrecht, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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18
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Kentin ZHA, Dautzenberg PLJ, Boelens HM, de Rooij SEJA, van Munster BC. [Not every delirium protocol in Dutch hospitals is up-to-date: evaluation of the implementation of the new delirium guideline]. Ned Tijdschr Geneeskd 2016; 160:D151. [PMID: 27438389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the extent to which the essential changes in the new Dutch delirium guideline for adults and the elderly, published in April 2014, have been incorporated in local hospital protocols, so as to estimate the consequences this could have for patients. DESIGN Quantitative study. METHOD Dutch hospital protocols were collected for two periods: before (September to December 2012) and after publication of the guideline (March to July 2015). Protocols were compared with respect to basic delirium care (screening, diagnostic approach, therapy and follow-up care) and organisation of care. RESULTS Of the 80 Dutch hospitals approached, we were able to include 57 (71%) protocols in this study. 16 hospitals (28%) had adapted their protocols to the new guideline. Screening for the risk of delirium using the questions from the Dutch safety management system (Veiligheidsmanagementsysteem) was described in 29 (51%) of the protocols. Use of the Delirium Observation Screening Scale was reported in 52 (91%) protocols. A policy of moderation regarding antipsychotic therapy was described in 12 of 53 (23%) protocols, but in 21/53 (40%) the haloperidol dosages were higher than advised by the guideline. Follow-up care is described in 40 (70%) of the protocols. Organisation of delirium care, for example restriction of consultation of an expert to complex cases, was advised in 33/57 (58%) protocols. CONCLUSION 15 months after publication, only just over a quarter of the protocols incorporated the guideline. In terms of the treatment of patients with delirium, this may have led to unnecessary treatment with antipsychotics. Furthermore, basic delirium care is apparently still not considered as the responsibility of every medical specialist in the hospital.
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Meulendijks FG, Hamaker ME, Boereboom FTJ, Kalf A, Vögtlander NPJ, van Munster BC. Groningen frailty indicator in older patients with end-stage renal disease. Ren Fail 2015; 37:1419-24. [PMID: 26337636 DOI: 10.3109/0886022x.2015.1077315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Currently over 55% of end-stage renal disease (ESRD) patients are aged ≥60 years and patients >75 years represent the fastest growing segment of the dialysis population. We aimed to assess whether the Groningen frailty indicator (GFI) can be used to distinguish fit older ESRD patients, likely able to tolerate and benefit from dialysis, from frail older patients who need further evaluation with a geriatrician's comprehensive assessment. METHODS All patients aged ≥65 years visiting the pre-dialysis unit at the Gelre hospital between 2007 and 2013 were included and underwent the GFI (n = 65). Patients with GFI ≥ 4 (frail) were referred for geriatric consultation (n = 13). Results of the GFI and nephrologists' evaluation were compared with geriatrician's assessment. Survival rates and outcomes after one year of follow up were recorded. RESULTS Twenty patients (32%) were identified as frail. Of the problems identified by the geriatrician in 13 patients, 55% were not reported in the nephrologists' notes. The first year after inclusion, 30% of patients with a GFI ≥ 4 died, compared to 9% of fit patients (p = 0.04). Moreover, 90% of frail patients had been hospitalized one or more times, compared to 53% in the fit group (p = 0.005). CONCLUSION Although the GFI can be a useful instrument to identify ESRD patients at risk, both the GFI and the nephrologists' assessment failed to identify specific geriatric impairments. Further research is needed to develop a specific frailty indicator for ESRD patients and to determine the value and effect of a comprehensive geriatric assessment in ESRD patients.
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Affiliation(s)
- F G Meulendijks
- a Department of Internal Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - M E Hamaker
- b Department of Geriatric Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - F T J Boereboom
- a Department of Internal Medicine , Diakonessenhuis Utrecht , The Netherlands
| | - A Kalf
- c Department of Geriatric Medicine , Gelre Hospitals , Apeldoorn , The Netherlands
| | - N P J Vögtlander
- d Department of Internal Medicine , Gelre Hospitals , Apeldoorn , The Netherlands , and
| | - B C van Munster
- c Department of Geriatric Medicine , Gelre Hospitals , Apeldoorn , The Netherlands .,e Department of Medicine , Academic Medical Centre, University of Amsterdam , Amsterdam , The Netherlands
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Blom MT, Jansen S, de Jonghe A, van Munster BC, de Boer A, de Rooij SE, Tan HL, van der Velde N. In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration. J Nutr Health Aging 2015; 19:583-9. [PMID: 25923490 DOI: 10.1007/s12603-015-0465-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms). DESIGN Prospective cohort study. SETTING Tertiary university teaching-hospital. PARTICIPANTS Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients. MEASUREMENTS Data from ECGs made before and after hip surgery (1-3 days and/or 4-6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis. RESULTS We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors. CONCLUSION QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.
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Affiliation(s)
- M T Blom
- Nathalie van der Velde, MD, PhD, Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Phone: 31-20-5663066, Fax: 31-20-5669325;
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van der Zaag-Loonen HJ, van Leeuwen RB, Bruintjes TD, van Munster BC. Prevalence of unrecognized benign paroxysmal positional vertigo in older patients. Eur Arch Otorhinolaryngol 2014; 272:1521-4. [PMID: 25488279 DOI: 10.1007/s00405-014-3409-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/06/2014] [Indexed: 10/24/2022]
Abstract
Dizziness is a relatively common complaint which occurs more often with increasing age. Benign paroxysmal positional vertigo (BPPV) is an important cause which can easily be treated but is frequently not recognized by professionals. The aim of this study was to assess the prevalence of unrecognized BPPV in older patients. Patients ≥70 years of age (n = 989) indicated whether they experienced dizziness, and if so whether the symptoms were typical for BPPV. If affirmed, a diagnostic maneuver was performed. Positive patients were treated at once. All suspected patients completed quality of life questionnaires and were followed for 3 and 6 months. Positive BPPV patients were compared with negative (but suspected) patients. Almost one quarter of the patients (226 patients, 23 %) suffered from dizziness, among whom 101 were suspected of BPPV. Less than half (n = 45) underwent the diagnostic maneuver, of whom 13 (29 %) were positive for BPPV. At follow-up, one patient developed BPPV, leading to a total of 14 positive patients (overall prevalence 1.4 %). BPPV positive patients did not differ from BPPV negative patients. Among a large group of older patients, one quarter experiences dizziness, and 1.4 % has definite BPPV.
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van der Jagt-Willems HC, van Munster BC, Leeflang M, Beuerle E, Tulner CR, Lems WF. Diagnosis of vertebral fractures on lateral chest X-ray: intraobserver agreement of semi-quantitative vertebral fracture assessment. Eur J Radiol 2014; 83:2177-2180. [PMID: 25445898 DOI: 10.1016/j.ejrad.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/02/2014] [Accepted: 09/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. METHODS To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately,blinded and in different time periods. Agreement and Cohens' kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. RESULTS 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95-98%for the two levels of fracturing, with a Cohen's kappa of 0.88-0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81-0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). CONCLUSION The results show good agreement and intraobserver reliability on the X-chest compared to the X-Tspine for visualizing vertebral fractures. The results of this study emphasizes that the routinely performed X-chest is reliable in order to diagnose vertebral fractures.
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Affiliation(s)
- H C van der Jagt-Willems
- Department of Geriatrics, Slotervaart Hospital, Amsterdam, The Netherlands; Department of Internal Medicine, Spaarne Hospital, Hoofddorp, The Netherlands.
| | - B C van Munster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - M Leeflang
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - E Beuerle
- Department of Radiology, Slotervaart Hospital, Amsterdam, The Netherlands
| | - C R Tulner
- Department of Geriatrics, Slotervaart Hospital, Amsterdam, The Netherlands
| | - W F Lems
- Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
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de Glas NA, Hamaker ME, Kiderlen M, de Craen AJM, Mooijaart SP, van de Velde CJH, van Munster BC, Portielje JEA, Liefers GJ, Bastiaannet E. Choosing relevant endpoints for older breast cancer patients in clinical trials: an overview of all current clinical trials on breast cancer treatment. Breast Cancer Res Treat 2014; 146:591-7. [DOI: 10.1007/s10549-014-3038-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/18/2014] [Indexed: 11/25/2022]
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Hamaker ME, Stauder R, van Munster BC. On-going clinical trials for elderly patients with a hematological malignancy: are we addressing the right end points? Ann Oncol 2014; 25:675-681. [PMID: 24458474 PMCID: PMC4433524 DOI: 10.1093/annonc/mdt592] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 12/06/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cancer societies and research cooperative groups worldwide have urged for the development of cancer trials that will address those outcome measures that are most relevant to older patients. We set out to determine the characteristics and study objectives of current clinical trials in hematological patients. METHOD The United States National Institutes of Health clinical trial registry was searched on 1 July 2013, for currently recruiting phase I, II or III clinical trials in hematological malignancies. Trial characteristics and study objectives were extracted from the registry website. RESULTS In the 1207 clinical trials included in this overview, patient-centered outcome measures such as quality of life, health care utilization and functional capacity were only incorporated in a small number of trials (8%, 4% and 0.7% of trials, respectively). Even in trials developed exclusively for older patients, the primary focus lies on standard end points such as toxicity, efficacy and survival, while patient-centered outcome measures are included in less than one-fifth of studies. CONCLUSION Currently on-going clinical trials in hematological malignancies are unlikely to significantly improve our knowledge of the optimal treatment of older patients as those outcome measures that are of primary importance to this patient population are still included in only a minority of studies. As a scientific community, we cannot continue to simply acknowledge this issue, but must all participate in taking the necessary steps to enable the delivery of evidence-based, tailor-made and patient-focused cancer care to our rapidly growing elderly patient population.
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Affiliation(s)
- M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht.
| | - R Stauder
- Department of Oncology and Hematology, Innbruck Medical University, Innsbruck, Austria
| | - B C van Munster
- Department of Internal Medicine, Academic Medical Center, Amsterdam; Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
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van der Jagt-Willems HC, Vis M, Tulner CR, van Campen JPCM, Woolf AD, van Munster BC, Lems WF. Mortality and incident vertebral fractures after 3 years of follow-up among geriatric patients. Osteoporos Int 2013; 24:1713-9. [PMID: 23052933 DOI: 10.1007/s00198-012-2147-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED In a prospective cohort study of 395 geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline. The mortality risk was independently associated with the presence of three or more vertebral fractures at baseline. In the surviving patients, the risk of incident fractures was noteworthy, occurring in 26 % of these patients. INTRODUCTION The purpose of this study is to determine mortality rate and the incidence of vertebral fractures in a geriatric outpatient group, during a 3-year follow-up period, in a teaching hospital in Amsterdam, The Netherlands. METHODS This study includes a prospective cohort study of 395 geriatric patients who had their baseline visit at a diagnostic day hospital in 2007 and 2008. They were invited for follow-up 3 years later. Lateral X-rays of the lumbar spine and chest were performed at baseline and after 3 years; vertebral fractures were scored in all patients according to the semi-quantitative method of Genant. RESULTS After 3 years, mortality was 46 % and associated with prevalent vertebral fractures at baseline (odds ratio (OR), 1.83; 95 % CI, 1.23-2.74). The presence of three or more vertebral fractures at baseline was an independent risk factor for mortality (OR, 3.32; 95 % CI, 1.56-7.07). Other independently associated risk factors were greater age, higher co-morbidity score, and having more prescriptions. Higher cognitive capacity protected against mortality after 3 years. In 72 patients, radiography was repeated. Nineteen patients (26 %) had an incident radiographic vertebral fracture: 16 in those with a prevalent fracture, and 3 in those without a prevalent vertebral fracture at baseline. CONCLUSIONS In geriatric outpatients, mortality after 3 years was associated with prevalent vertebral fractures at baseline, and the mortality risk was independently associated with 3 or more vertebral fractures at baseline. In survivors, the risk of incident fractures was noteworthy, since these occurred in 26 % of the patients, particularly in those with a prevalent vertebral fracture.
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Manenschijn L, van Rossum EFC, Jetten AM, de Rooij SE, van Munster BC. Glucocorticoid receptor haplotype is associated with a decreased risk of delirium in the elderly. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:316-21. [PMID: 21438141 DOI: 10.1002/ajmg.b.31165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/01/2010] [Indexed: 11/09/2022]
Abstract
Delirium is the most common mental disorder at older age in hospitals after acute admission. The pathogenesis of delirium is largely unknown. Hyperactivity of the hypothalamic-pituitary-adrenal axis, leading to increased cortisol levels, has been suggested to play a role in the development of delirium. The effects of cortisol, the most important glucocorticoid (GC) in humans, are mainly mediated by the GC receptor (GR). Several polymorphisms in the GR gene that alter the GC sensitivity are known. The aim of this study was to study the role of these GR polymorphisms in delirium in elderly patients. Patients aged 65 years and older admitted to the medical department or scheduled for hip surgery were included. Delirium was diagnosed using the Confusion Assessment Method. Five single nucleotide polymorphisms in the GC receptor gene were genotyped and haplotypes were constructed. Delirium was associated with impaired cognitive (P < 0.001) and functional function (P < 0.001), as well as with older age (P < 0.001). Homozygous carriers of haplotype 4, characterized by the presence of the BclI and TthIIII minor alleles, had a 92% decreased risk of developing delirium (P = 0.02), independent of age, cognitive, and functional state. Homozygous carriage of the BclI-TthIIII haplotype of the GR gene is related to a reduced risk of developing delirium. This suggests that altered GC signaling may be involved in the pathogenesis and development of delirium in the elderly.
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Affiliation(s)
- L Manenschijn
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
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van Munster BC, Baas MC. A 77-year-old female with macroglossia. Neth J Med 2011; 69:136-140. [PMID: 21444941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- B C van Munster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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de Jonghe A, Korevaar JC, van Munster BC, de Rooij SE. Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia. Are there implications for delirium? A systematic review. Int J Geriatr Psychiatry 2010; 25:1201-8. [PMID: 21086534 DOI: 10.1002/gps.2454] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Circadian rhythm disturbances, like sundowning, are seen in dementia. Because the circadian rhythm is regulated by the biological clock, melatonin might be effective in the treatment of these disturbances. We systematically studied the effect of melatonin treatment in patients with dementia. In addition, we elaborate on the possible effects one might expect of melatonin treatment in patients with delirium, since dementia and delirium are strongly related. Moreover, some evidence exists that sundowning in patients with dementia and the alterations in the sleep/wake cycle, seen in patients with delirium both originate from circadian rhythm disturbances. DESIGN A systematic search of the literature, published between 1985 and April 2009, was performed using PubMed and other databases. All papers on melatonin treatment in dementia were retrieved. Effects of melatonin on circadian rhythm disturbances were scored by means of scoring sundowning/agitated behaviour, sleep quality and daytime functioning. RESULTS Nine papers, including four randomised controlled trials (RCTs) (n = 243), and five case series (n = 87) were reviewed. Two of the RCTs found a significant improvement on sundowning/agitated behaviour. All five case series found an improvement. The results on sleep quality and daytime functioning were inconclusive. CONCLUSION Sundowning/agitated behaviour improves with melatonin treatment in patients with dementia. There are several arguments that sundowning in patients with dementia and the alterations in the sleep/wake cycle in patients with delirium have a common background, namely a disturbance of the circadian rhythm. This suggests that melatonin treatment could also have the same positive effects in patients with delirium.
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Affiliation(s)
- A de Jonghe
- Department of Internal Medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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