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Puar T.H.,Changi General Hospital | Khoo J.J.,Changi General Hospital | Cho L.W.,Changi General Hospital | Cho L.W.,National University of Singapore | And 7 more authors.
Journal of the American Geriatrics Society | Year: 2012

Objectives To determine whether tight glycemic control is associated with greater risk of hip fractures in individuals being treated for type 2 diabetes mellitus. Design Case-control study. Setting Tertiary hospital. Participants Cases were selected from all individuals with diabetes mellitus admitted between 2005 and 2010 to Changi General Hospital for hip fracture (N = 932). Cases were included if their glycosylated hemoglobin (HbA1c) had been measured within 3 months of the fracture and they were undergoing treatment with oral hypoglycemic medications or insulin. Each case was matched with one control for sex, age, race, duration of diabetes mellitus, and comorbidities. Measurements Information on baseline characteristics, HbA1c, and use of diabetic medications was obtained. The likelihood of hip fracture was determined comparing four different values of HbA1c [<6%, 6.1-7.0%, 7.1-8.0%, >8% (reference group)] and use of diabetic medications. Results The mean age of cases was 77.3 ± 7.7, and 73.3% were female. After adjusting for age, sex, race, comorbidities, and other covariates, participants with tighter glycemic control (HbA1c < 6% and 6.1-7.0%) were more likely to have a hip fracture than those with HbA1c >8% (odds ratio (OR) = 3.01, 95% confidence interval (CI) = 2.01-4.51, P <.001; and OR = 2.34, 95% CI=1.71-3.22, P <.001, respectively). The use of insulin and sulfonylurea was similar between cases and controls. Conclusion The present study found an association between tight glycemic control (when HbA1c < 7%) and greater risk of hip fracture in individuals being treated for type 2 diabetes mellitus. Greater caution needs to be exercised in treating older patients with diabetes mellitus. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society. Source

Caplan G.,Geriatric Medicine
Australian Prescriber | Year: 2011

Delirium is an acute syndrome characterized by altered levels of consciousness, attention and cognitive function. It has many causes and frequently leads to, or occurs during, hospitalisation. Delirium requires urgent medical assessment. Unfortunately, the diagnosis is often missed. It is best treated by multidisciplinary intervention, addressing risk factors, treating underlying causes and minimising harm. Part of its management may be pharmacological, firstly ceasing drugs which may precipitate delirium - especially those with anticholinergic properties - and secondly, cautious use of antipsychotics for hyperactive symptoms. Source

Etherton-Beer C.D.,University of Western Australia | Inglis T.,Geriatric Medicine | Waterer G.,University of Western Australia
Respirology | Year: 2015

Residents in 11 long-term care facilities, and presenting to a single tertiary hospital site, were sampled to estimate prevalence of oropharyngeal colonization with resistant Gram-negative bacteria. From 124 residents, only one isolate (0.8%; 95% confidence interval 0.0%, 4.4) was multi-resistant (an extended-spectrum β-lactamase producing Escherichia coli) indicating that different treatment recommendations for respiratory infections in this population may not be justified. © 2015 Asian Pacific Society of Respirology. Source

Granziera S.,Kings College | Granziera S.,University of Padua | Hasan A.,Geriatric Medicine | Cohen A.T.,Kings College London
Clinical and Applied Thrombosis/Hemostasis | Year: 2016

Direct oral anticoagulants (DOACs) have been compared with standard therapy in large phase III studies to assess their safety and efficacy in the treatment of deep vein thrombosis and/or pulmonary embolism and in the secondary prevention of recurrent venous thromboembolism. Although the mean population age and the gross inclusion and exclusion criteria were similar across these studies, they differed in other aspects such as overall study design and acute treatment strategies. The 4 DOACs examined in phase III trials (apixaban, edoxaban, rivaroxaban, and dabigatran) showed noninferiority compared with standard therapy for the treatment of deep vein thrombosis and/or pulmonary embolism and for the prevention of recurrent venous thromboembolism. Furthermore, these DOACs exhibited a similar safety profile to standard therapy, with the risk of major bleeding significantly reduced in some of these studies. Rivaroxaban and apixaban were tested as a single-drug approach, whereas in the dabigatran and edoxaban studies, initial bridging with parenteral agents was employed. The purpose of this review is to compare the phase III studies of DOACs in this indication, to highlight the differences, and to discuss a series of clinically relevant issues, including the management of key patient subgroups (eg, fragile patients, those with cancer or renal impairment), extended treatment, use of comedications, heparin pretreatment versus a single-drug approach, and the bleeding profiles of the DOACs. © SAGE Publications. Source

Dodds R.,Geriatric Medicine | Dodds R.,University of Southampton | Denison H.J.,University of Southampton | Ntani G.,University of Southampton | And 4 more authors.
Journal of Nutrition, Health and Aging | Year: 2012

Objective: Lower muscle strength is associated with a range of adverse health outcomes in later life. The variation in muscle strength between individuals is only partly accounted for by factors in adult life such as body size and physical activity. The aim of this review was to assess the strength of the association between intrauterine development (indicated by birth weight) and subsequent muscle strength. Design: Systematic review and meta-analysis of studies that assessed the association between birth weight and subsequent muscle strength. Results: Nineteen studies met inclusion criteria with 17 studies showing that higher birth weight was associated with greater muscle strength. Grip strength was used as a single measure of muscle strength in 15 studies. Metaanalysis (13 studies, 20 481 participants, mean ages 9.3 to 67.5) showed a 0.86 kg (95% CI 0.58, 1.15) increase in muscle strength per additional kilogram of birth weight, after adjustment for age, gender and height at the time of strength measurement. Conclusion: This review has found consistent evidence of a positive association between birth weight and muscle strength which is maintained across the lifecourse. Future work will be needed to elucidate the biological mechanisms underlying this association, but it suggests the potential benefit of an early intervention to help people maintain muscle strength in later life. The Journal of Nutrition, Health and Aging © Volume 16, Number 7, 2012. Source

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