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Preserving Cognition in Older African Americans with Mild Cognitive Impairment
Author(s) -
Rovner Barry W.,
Casten Robin J.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14012
Subject(s) - medicine , cognition , psychological intervention , gerontology , cognitive decline , glycemic , randomized controlled trial , verbal memory , verbal learning , neuropsychology , dementia , diabetes mellitus , type 2 diabetes mellitus , clinical psychology , psychiatry , disease , endocrinology
was also corrected. Rational prescribing in very old adults can be challenging for physicians who are not specialists in pharmacotherapy in old age (e.g., GPs) because evidence-based guidelines are not of great help in capturing the medical complexity of this population. Applying data from narrowly defined clinical trials that enroll mostly younger, healthier individuals to the entire spectrum of older adults is inappropriate and possibly even harmful in most situations. To achieve the best possible balance between benefits and risks of treatment regimens, GPs must set treatment priorities according to their medical experience and skills. With this in mind, it is important that geriatricians actively contribute to the continuing education of GPs. Using explicit criteria (e.g., Beers or Screening Tool of Older People’s potentially inappropriate Prescriptions/ Screening Tool to Alert doctors to Right Treatment criteria) as tools to optimize complex treatment regimens can be a way to generate more-comprehensive medical reports. Even if explicit criteria were not used in this study, 91.6% of GPs declared that therapeutic changes were notified in the report and for 83.3% of them were carefully explained and justified. Although GPs thought that geriatricians were specialists in pharmacotherapy for older adults, 25% of the secondary medication modifications by GPs were not related to specific medical reason, and 8% were made according to advice from another specialist given after discharge from the rehabilitation division (e.g., cardiologist, gastroenterologist, neurologist, psychiatrist). The last finding was that GPs desired more-frequent contacts with geriatricians, especially when they have optimized the appropriateness of medication regimens according to the complexity of older, vulnerable individuals; 54% felt that optimization had complicated patient management. These results emphasize the active role that GPs play in the adherence of frail, polymedicated, and polymorbid individuals to recommendations for complex drug regimens. They also underline the need to enhance continuity of care between hospital and the community.