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Was ist bei 80+ evidenzbasiert?

What is evidence based in older adults above 80?

Hypertonie, Antikoagulation, Osteoporose

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MMW - Fortschritte der Medizin Aims and scope

Eine 84-jährige Frau mit Hypertonie, bekanntem Vorhofflimmern sowie Z. n. pertrochantärer Femurfraktur vor einem Jahr nach häuslichem Sturz ist seit dem Trauma in wesentlichen Bereichen auf Hilfe angewiesen und lebt daher im Pflegeheim. Anhand dieses Beispiels diskutiert der Autor die Möglichkeiten und Grenzen der Therapie.

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Literatur

  1. Kuijpers MA, van Marum RJ, Egberts AC, Jansen PA, Group OS (2008) Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 65 (1):130–133. doi:https://doi.org/10.1111/j.1365-2125.2007.02961.x

    Article  Google Scholar 

  2. Muhlbauer V, Dallmeier D, Brefka S, Bollig C, Voigt-Radloff S, Denkinger M (2019) The Pharmacological Treatment of Arterial Hypertension in Frail, Older Patients-a Systematic Review. Dtsch Arztebl Int 116 (3):23–30. doi:https://doi.org/10.3238/arztebl.2019.0023

    PubMed  PubMed Central  Google Scholar 

  3. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ, Group HS (2008) Treatment of hypertension in patients 80 years of age or older. N Engl J Med 358 (18):1887–1898. doi:https://doi.org/10.1056/NEJMoa0801369

    Article  CAS  Google Scholar 

  4. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, Kitzman DW, Kostis JB, Krousel-Wood MA, Launer LJ, Oparil S, Rodriguez CJ, Roumie CL, Shorr RI, Sink KM, Wadley VG, Whelton PK, Whittle J, Woolard NF, Wright JT, Jr., Pajewski NM, Group SR (2016) Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged >/=75 Years: A Randomized Clinical Trial. JAMA 315 (24):2673–2682. doi:https://doi.org/10.1001/jama.2016.7050

    Article  CAS  Google Scholar 

  5. Tulner LR, Kuper IM, van Campen JP, Koks CH, Mac Gillavry MR, Beijnen JH, Brandjes DP (2009) Treatment of hypertension in an elderly outpatient population in the Netherlands. Am J Geriatr Pharmacother 7 (4):204–209. doi:https://doi.org/10.1016/j.amjopharm.2009.08.002

    Article  Google Scholar 

  6. Warwick J, Falaschetti E, Rockwood K, Mitnitski A, Thijs L, Beckett N, Bulpitt C, Peters R (2015) No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med 13:78. doi:https://doi.org/10.1186/s12916-015-0328-1

    Article  Google Scholar 

  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Group ESCSD (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37 (38):2893–2962. doi:https://doi.org/10.1093/eurheartj/ehw210

    Article  Google Scholar 

  8. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007) Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 115 (21):2689–2696. doi:https://doi.org/10.1161/CIRCULATIONAHA.106.653048

    Article  CAS  Google Scholar 

  9. Friberg L, Rosenqvist M, Lip GY (2012) Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. Circulation 125 (19):2298–2307. doi:https://doi.org/10.1161/CIRCULATIONAHA.111.055079

    Article  CAS  Google Scholar 

  10. Man-Son-Hing M, Nichol G, Lau A, Laupacis A (1999) Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med 159 (7):677–685. doi:https://doi.org/10.1001/archinte.159.7.677

    Article  CAS  Google Scholar 

  11. Donze J, Rodondi N, Waeber G, Monney P, Cornuz J, Aujesky D (2012) Scores to predict major bleeding risk during oral anticoagulation therapy: a prospective validation study. Am J Med 125 (11):1095–1102. doi:https://doi.org/10.1016/j.amjmed.2012.04.005

    Article  Google Scholar 

  12. Gosch M, Iglseder B, Heppner HJ (2016) [Falls and dementia are not contraindications for anticoagulation in older adults with atrial fibrillation]. Z Gerontol Geriatr 49 (5):458–459. doi:https://doi.org/10.1007/s00391-016-1088-z

    Article  CAS  Google Scholar 

  13. Bahrmann P, Harms F, Schambeck CM, Wehling M, Flohr J (2016) [New oral anticoagulants for prophylaxis of stroke. Results of an expert conference on practical use in geriatric patients]. Z Gerontol Geriatr 49 (3):216–226. doi:https://doi.org/10.1007/s00391016-1027-z

    Article  Google Scholar 

  14. Feeney JM, Santone E, DiFiori M, Kis L, Jayaraman V, Montgomery SC (2016) Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: A TQIP study. J Trauma Acute Care Surg 81 (5):843–848. doi:https://doi.org/10.1097/TA.0000000000001245

    Article  CAS  Google Scholar 

  15. Feeney JM, Neulander M, DiFiori M, Kis L, Shapiro DS, Jayaraman V, Marshall WT, 3rd, Montgomery SC (2017) Direct oral anticoagulants compared with warfarin in patients with severe blunt trauma. Injury 48 (1):47–50. doi:https://doi.org/10.1016/j.injury.2016.08.016

    Article  Google Scholar 

  16. Larsen TB, Skjoth F, Nielsen PB, Kjaeldgaard JN, Lip GY (2016) Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. BMJ 353:i3189. doi:https://doi.org/10.1136/bmj.i3189

    Article  Google Scholar 

  17. Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92 (4):1415–1423. doi:https://doi.org/10.1210/jc.2006-1404

    Article  CAS  Google Scholar 

  18. Gosch M, Kammerlander C, Nicholas JA (2014) Treatment of osteoporosis in older adults. Panminerva Med 56 (2):133–143

    PubMed  CAS  Google Scholar 

  19. Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, ColonEmeric C, Kilgore ML, Morrisey MA, Saag KG, Safford MM, Warriner A, Delzell E (2010) Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc 11 (8):584591. doi:https://doi.org/10.1016/j.jamda.2009.12.004

    Article  Google Scholar 

  20. Zullo AR, Zhang T, Lee Y, McConeghy KW, Daiello LA, Kiel DP, Mor V, Berry SD (2019) Effect of Bisphosphonates on Fracture Outcomes Among Frail Older Adults. J Am Geriatr Soc 67 (4):768–776. doi:https://doi.org/10.1111/jgs.15725

    Article  Google Scholar 

  21. Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, Kelley A, Matlock D, Ouellet J, Rich MW, Schoenborn NL, Tinetti ME (2019) Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. J Am Geriatr Soc 67 (4):665–673. doi:https://doi.org/10.1111/jgs.15809

    Article  Google Scholar 

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Gosch, M. Was ist bei 80+ evidenzbasiert?. MMW - Fortschritte der Medizin 162, 42–45 (2020). https://doi.org/10.1007/s15006-020-0339-5

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  • DOI: https://doi.org/10.1007/s15006-020-0339-5

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