Informatics Center Knowledge Management / Eskind Biomedical Library Geriatrics Evidence Alert

Geriatrics Evidence Alert
September 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.  FDA News & Safety Advisories

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

    Helpful components of a caregiver hot line

    Question: What components of a caregiver hot line are most helpful to caregivers and are there any outcome measures?

    Bottom Line: The literature on hotlines for caregivers of older persons mainly revolves around help for caregivers in regard to palliative care or providing information and referral services to caregivers of persons with dementia. No studies were found that directly examined preferred components of a caregiver hotline and outcome measures. However, three articles were located and selected for their discussion on use of a caregiver hotline, on aspects addressed by the hotline (e.g. information, referral, counseling), and on perceived support needs of family caregivers. [full text »]


    Benefits of providing respite care to caregivers

    Question: What are some measurable benefits of respite care to caregivers?

    Bottom Line: The literature on respite care to caregivers is vast, primarily pertaining to caregivers with loved ones with dementia or mental illness. Articles that measured benefits to caregivers were somewhat sparse and there were references to the question of whether respite care is actually effective for caregivers long term, perhaps due more to variance in study design and quality than lack of benefit of the interventions. [full text »]


    Bibliography: Measuring caregiver stress and using support programs to reduce caregiver burden

    Question: Can you see what information is available on caregiver burden (geriatric patients)? What instruments are there that measure caregiver stress? What support programs help reduce caregiver stress?

    Bottom Line: Several instruments were located that measure caregiver burden or stress on primary caregivers from caring for older (geriatric) adults. Citations with abstracts for the articles that describe each instrument are organized by publication date. [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/vumcdiglib/geriatrics/info/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

    American Geriatrics Society publishes recommendations on pharmacological management of persistent pain

    Bottom Line: The American Geriatrics Society (AGS) panel on the pharmacological management of persistent pain in older adults reviews the literature on assessment and management of persistent pain, pharmacotherapy, and the risks and benefits of long-term opioid therapy. The panel also outlines 27 evidence-based recommendations regarding the use of nonopioids, opioids, adjuvant analgesics drugs, and other drugs, such as corticosteroids, topical lidocaine, and topical NSAIDs. [full text »]
    Reference: American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological Management of Persistent Pain in Older Persons. J Am Geriatr Soc. 2009 Jul 1. [Epub ahead of print] PubMed PMID: 19573219.


    USPSTF finds insufficient evidence for screening for impaired visual acuity in older adults

    Bottom Line: The United States Preventive Services Task Force (USPSTF) reported that the available evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity (defined as corrected vision worse than 20/40 but better than 20/200) associated with uncorrected refractive errors, cataracts, and AMD in adults aged 65 years and older in the primary care setting. This statement does not include screening for glaucoma. The USPSTF noted that "Screening questions are not as accurate as visual acuity testing for identifying visual acuity impairment. Evidence is limited on the use of other vision tests, including pinhole testing, the Amsler grid (a chart used to test central vision in order to detect AMD), or funduscopy (visual inspection of the interior of the eye), in screening in primary care to detect visual impairment due to AMD or cataracts." [full text »]
    Reference: Screening for Impaired Visual Acuity in Older Adults. U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 July [Accessed August 29, 2009]

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  1. Recently Published Research

    Randomized controlled trial shows mortality benefit and long term cost effectiveness of ultrasound screening for AAA in older adults

    Bottom Line: This multicenter, randomized controlled trial conducted in the United Kingdom examined the effects of screening for abdominal aortic aneurysm (AAA) in older adults given a population-based sample of 67, 770 men aged 65-74 years old seen primarily in primary care settings. Participants were randomized to receive either no screening (control group, n=33,887) or ultrasound screening(n= 33, 883) plus surveillance of those with screening-detected AAA (n=1334) and surgery as needed. After 10 years of follow-up, results showed that the absolute risk of death related to abdominal aortic aneurysm in screened participants was 0.46% compared to 0.87% in controls (relative risk reduction 48%, 95% CI: 37%- 57%). Screening for AAA was also determined to be cost effective long term. [full text »]
    Reference: Thompson SG, Ashton HA, Gao L, Scott RA; Multicentre Aneurysm Screening Study Group. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009 Jun 24;338:b2307. doi: 10.1136/bmj.b2307. PubMed PMID: 19553269.


    Randomized clinical trial finds response to high dose flu vaccine in older adults superior to low dose

    Bottom Line: This multicenter, randomized, double-blind clinical trial conducted in the United States compared high-dose(HD) influenza vaccine containing 60 mg of hemagglutinin per strain to the licensed standard-dose (SD) vaccine containing 15 mg of hemagglutinin per strain in medically stable community-dwelling adults ages 65 years and older. Results at 28 days post injection showed that subjects who received the HD vaccine (n=2575) had significantly higher rates of seroconversion and mean hemagglutination inhibition titers compared to those who received SD vaccine (n=1262). Follow- up at 6 months showed local reactions occurred more frequently in subjects who received HD vaccine; however, these were mild to moderate and brief. Overall, the investigators found the immunogenicity of the HD vaccine superior to the SD vaccine in older adults. [full text »]
    Reference: Falsey AR, Treanor JJ, Tornieporth N, Capellan J, Gorse GJ. Randomized, double-blind controlled phase 3 trial comparing the immunogenicity of high-dose and standard-dose influenza vaccine in adults 65 years of age and older. J Infect Dis. 2009 Jul 15;200(2):172-80. PubMed PMID: 19508159.

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  1. FDA News & Safety Advisories

    CDC releases second mental health and aging Issue brief: Evidence-based programs for depression in older adults

    Bottom Line: This brief from the Centers for Disease Control focuses on depression in older adults as a public health issue and describes in detail three examples of successful evidence-based community programs geared to improve their mental health and quality of life: 1) IMPACT (Improving Mood-Promoting Access to Collaborative Treatment), 2) PEARLS (Program to Encourage Active Rewarding Lives for Seniors), and 3) Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors). [full text »]
    Reference: The State of Mental Health and Aging in America Issue Brief #2: Addressing Depression in Older Adults: Selected Evidence- Based Programs. Atlanta (GA): Centers for Disease Control and Prevention. 2009. [Accessed August 29, 2009]


    FDA approves new injectable form of ibuprofen to treat pain and fever

    Bottom Line: The U.S. Food and Drug Administration approved Caldor, an injectable form of ibuprofen, for hospital use to treat pain and fever. The FDA cautioned use in patients with congestive heart failure, kidney impairment, those at risk of blood clots, and those who have a prior history of ulcers or gastrointestinal bleeding. High blood pressure, serious skin reactions, and serious allergic reactions are associated with use of Caldor. [full text »]
    Reference: FDA Approves Injectable Form of Ibuprofen. [Internet]. FDA News Release. Rockville, (MD): U.S. Food & Drug Administration. June 11, 2009. [Accessed August 29, 2009]


    FDA approves Onglyza (saxagliptin) to treat type 2 diabetes

    Bottom Line: The U.S. Food and Drug Administration recently approved a once-daily tablet called Onglyza (saxagliptin) for use with diet and exercise to treat type 2 diabetes. Onqlyza, a dipeptidyl peptidase-4 (DPP-4) inhibitor, was approved primarily based on the results of eight clinical trials of patients with a low risk for cardiovascular events. The FDA is requiring post market study of cardiovascular safety in higher risk patients. [full text »]
    Reference: FDA Approves New Drug Treatment for Type 2 Diabetes. [Internet]. FDA News Release. Rockville, (MD): U.S. Food & Drug Administration. July 31, 2009. [Accessed August 29, 2009]


    FDA approves new statin for lowering cholesterol levels

    Bottom Line: The U.S. Food and Drug Administration recently approved Livalo (pitavastatin), a new HMG-CoA reductase inhibitor intended for use in patients with elevated or abnormal blood cholesterol levels. Approval was based on the results of 5 clinical trials that compared Livalo to three currently marketed statins. [full text »]
    Reference: FDA Approves New Cholesterol-Lowering Drug. [Internet]. FDA News Release. Rockville, (MD): U.S. Food & Drug Administration. August 3, 2009. [Accessed August 29, 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/biolib/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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