Informatics Center Knowledge Management / Eskind Biomedical Library Geriatrics Evidence Alert

Geriatrics Evidence Alert
February 2009


The Geriatrics Evidence Alert is an electronic newsletter developed by the Outpatient Clinical Informatics Consult Service (OCICS) at the Eskind Biomedical Library to provide a monthly update of selected evidence-based biomedical literature and recently published news and research to clinicians and other health professionals who provide clinical services for older adults at Vanderbilt University Medical Center and the Middle Tennessee area.

In this issue...


  1.  Clinical questions recently sent to the EBM Literature Request message basket in StarPanel
  2.  Clinical Practice Guidelines
  3.  Newly Published Research
  4.  CDC & FDA News

DISCLAIMER: The Informatics Center Knowledge Management / Eskind Biomedical Library Geriatrics Evidence Alert is a current awareness tool prepared solely for informational purposes for the convenience of the clinician and other healthcare professionals. Librarians at the Eskind Biomedical Library attempt to provide accurate, inclusive, and informative reports. The information provided in the alert is not a substitute for clinical judgment. Biomedical practitioners should therefore take careful consideration of the original evidence presented in the full-text of the articles cited before taking action. This educational material is produced with the support of the Vanderbilt-Reynolds Geriatrics Education Center.




  1. Clinical questions recently sent to the EBM Literature Request message basket in StarPanel

    Bibliography: Orthogeriatric services in the co-management of elderly patients with hip fractures

    Question: Please locate articles on co-management of patients with geriatrics and orthopedic surgery services similar to the following JAGS article on co-management of hip fractures: Friedman, S. M., D. A. Mendelson, et al. (2008). "Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population." J Am Geriatr Soc 56(7): 1349-56. PMID: 18503520

    Bottom Line: Over 40 articles were located relating to the co-management of patients with geriatrics and orthopedic surgery services (orthogeriatrics). A bibliography of references with original abstracts was developed with links to PubMed and full-text when available. [full text »]


    Bibliography: Carotid stenting for reducing cerebrovascular accident risk in older persons

    Question: What are the outcomes of carotid stenting in reducing CVA risk?

    Bottom Line: Over 30 articles and practice guidelines were located related to the use of carotid stenting for reducing CVA risk. A bibliography of references with original abstracts was developed with links to PubMed and full-text when available. [full text »]


    Statistical data located for accidental falls for older females

    Question: Find Tennessee data on accidental falls for females age 65 and older.

    Bottom Line: Tennessee data from the Hospital Discharge Inpatient Survey and the Traumatic Brain Injury database was accessed through the Tennessee Health Department website and Health Statistics section to create two spreadsheets of data. Hospital admission data show an increase in the last 5 years for females from 11,794 falls in 2002 to 12,803 in 2006. The sharpest increase occurred in females age 80 years old and over: 7,050 in 2002 versus 7,782 in 2006. The TBI spreadsheet does NOT include concussions or visits to the emergency room. [full text »]


For Vanderbilt University Medical Center physicians: To submit a complex clinical question via StarPanel for searching and synthesis of the medical literature, select the message basket link entitled EBM Literature Request located below the message box (also in each of the four VIM suite drop-down menus) and type your question, including preferred turn-around time. To view the evidence summaries for all geriatrics-related clinical questions previously submitted to the EBM Literature Request message basket, visit http://www.mc.vanderbilt.edu/km/geriatrics/index.html and select the paper icon under Details to view the evidence summary for each question.

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  1. Clinical Practice Guidelines

    Infectious Disease Society of America updates guidelines on evaluation of fever and infection in older adult residents of long-term care facilities

    Bottom Line: This update of the previous guidelines from 2000 provides an overview on clinical evaluation and diagnostic testing for fever and infections in residents in long term care facilities. Recommendations cover topics such as criteria for fever and symptoms suggesting infection, which clinical evaluations to perform for suspected infection, which laboratory tests to order, and how to investigate a suspected outbreak of a specific infectious disease. Summaries of the current research evidence are included to support each recommendation. [full text »]
    Reference: High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jan 15;48(2):149-71. PMID: 19072244

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  1. Recently Published Research

    Randomized placebo-controlled trial shows improvement in anxiety in older adults taking Lexapro®

    Bottom Line: This randomized, double-blind, clinical trial examined the efficacy and safety of the Selective serotonin reuptake inhibitor Lexapro (escitalopram) versus placebo for 12 weeks in adults ages 60 and over with generalized anxiety disorder (GAD). Results showed that Lexapro had a better cumulative response and improvement in anxiety symptoms compared to placebo. [full text »]
    Reference: Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF 3rd. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. JAMA. 2009 Jan 21;301(3):295-303. PMID: 19155456


    Ginkgo biloba not effective in reducing overall incidence rates of dementia or Alzheimer's

    Bottom Line: This randomized, double-blind, placebo-controlled clinical trial called the Ginkgo Evaluation of Memory (GEM) study examined the effectiveness of Ginkgo biloba versus placebo in reducing the incidence of all-cause dementia and Alzheimer disease (AD) in elderly persons ages 75 years and older with normal cognition and those with mild cognitive impairment (MCI). Participants were randomized to either 120-mg Ginkgo biloba extract twice-daily or placebo. The primary efficacy end point was the diagnosis of dementia. Median follow-up was 6.1 years (maximum, 7.3 years). Results showed no significant difference between groups for preventing or delaying the onset of all-cause dementia; nor did Ginkgo biloba have an effect on the risk for developing AD. The overall dementia rate was 3.3 per 100 person-years in participants assigned to Ginkgo biloba versus 2.9 per 100 person-years in the placebo group. [full text »]
    Reference: DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA, Lopez OL, Burke G, Carlson MC, Fried LP, Kuller LH, Robbins JA, Tracy RP, Woolard NF, Dunn L, Snitz BE, Nahin RL, Furberg CD; Ginkgo Evaluation of Memory (GEM)Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62. PMID: 19017911


    Positive effect found on weight and appetite with omega-3 fatty acid supplementation in older adults with mild to moderate Alzheimer's Disease

    Bottom Line: This randomized, double-blind trial assessed the effects of omega-3 fatty acid supplementation versus placebo on weight and appetite over 12 months in 204 patients with mild to moderate Alzheimer's disease. Eighty-nine patients received 1.7 g of docosahexaenoic acid (DHA) and 0.6 g of eicosapentaenoic acid (EPA) (Omega-3/Omega-3 group) and 85 patients received placebo consisting of 0.6 g of linoleic acid per day (placebo/Omega-3 group) for 6 months. All patients received a course of DHA and EPA for another 6 month for a total of 12 months of treatment. Results showed a significant increase in body weight at 6 and 12 months for the Omega-3/Omega-3 group compared to baseline. No change in weight was seen at 6 months with the placebo/Omega-3 group but a significant increase was noted at 12 months following initiation for 6 months of supplementation. Appetite also improved in the Omega-3/Omega-3 group during 12 months of treatment. [full text »]
    Reference: Irving GF, Freund-Levi Y, Eriksdotter-Jönhagen M, Basun H, Brismar K, Hjorth E, Palmblad J, Vessby B, Vedin I, Wahlund LO, Cederholm T. Omega-3 fatty acid supplementation effects on weight and appetite in patients with Alzheimer's disease: the omega-3 Alzheimer's disease study. J Am Geriatr Soc. 2009 Jan;57(1):11-7. Epub 2008 Nov 20. PMID: 19054188

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  1. CDC & FDA News

    CDC publishes issue brief on the state of mental health and aging in America

    Bottom Line: The CDC released the first of two issue briefs on the state of mental health and aging in the United States. The issue brief covers why mental health is a public health issue, provides statistical data on mental health problems in older adults, and reviews the results of the CDC's Behavioral Risk Factor Surveillance System (BRFSS) questions on mental health. Topics covered by the BRFSS include life satisfaction, emotional and social support, frequent mental distress, current depression, and lifetime diagnosis of depression and anxiety disorder. [full text »]
    Reference: Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The state of mental health and aging in America issue brief 1: what do the data tell us? Atlanta, GA: National Association of Chronic Disease Directors; 2008. [Accessed February 24, 2009]

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About Geriatrics Evidence Alert
The Geriatrics Evidence Alert is a monthly electronic newsletter developed by the Outpatient Clinical Informatics Consult Service (OCICS) at the Eskind Biomedical Library (EBL) to provide an update of selected evidence-based biomedical literature published in the past 30 to 60 days to physicians practicing at the Vanderbilt Internal Medicine department at Vanderbilt University Medical Center. The newsletter is also intended for Vanderbilt University partners and affiliates in the Nashville/Middle Tennessee area who provide clinical, research, and medical education services in the field of Geriatrics.

About OCICS
The OCICS provides current research evidence to support effective clinical decision-making and evidence-based practice by linking evidence expertise into clinical workflow using informatics tools.

How to Submit Clinical Questions to the OCICS for Research
For Vanderbilt physicians: To submit a complex clinical question to OCICS, select NewMsg from within your patient's chart in StarPanel and type your question, including your preferred turn-around time. To send the message, choose the blue link entitled EBM Literature Request located below the message box, or select the basket entitled EBM Literature Request located in each of the VIM suite drop-down menus. Complex questions submitted via NoMR messages for general knowledge building are also welcomed. To view literature summaries for all clinical questions previously submitted, visit the OCICS web site at http://www.mc.vanderbilt.edu/km/ocics/index.html.

Contact Us
For more information about OCICS or the Geriatrics Evidence Alert newsletter, contact Zachary Fox at zachary.e.fox@vanderbilt.edu.

DISCLAIMER: The Informatics Center Knowledge Management / Eskind Biomedical Library Geriatrics Evidence Alert is a current awareness tool prepared solely for informational purposes for the convenience of the clinician and other healthcare professionals. Librarians at the Eskind Biomedical Library attempt to provide accurate, inclusive, and informative reports. The information provided in the alert is not a substitute for clinical judgment. Biomedical practitioners should therefore take careful consideration of the original evidence presented in the full-text of the articles cited before taking action. This educational material is produced with the support of the Vanderbilt-Reynolds Geriatrics Education Center.



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