Evidence-Based Medicine and Geriatrics

Abstract

Session Description/Moderator Details.- Evidence-based medicine in geriatrics Geriatric patients often have multiple chronic conditions, use many medications and may suffer from cognitive and functional impairments. A study about prevalence of morbidities in the elderly showed, that 82% of patients aged 65 and over had at least one chronic condition; 24% had even four or more conditions 1]. Due to deteriorating organ functions they are prone to medication-related side effects 2]. Considering these complex problems, arriving at the best treatment for individual older people is complicated. To provide the best care, doctors need to base their decision on the best available evidence. When considering evidence-based medicine in geriatrics, several problems need to be addressed. In the first place, solid evidence concerning elderly is scarce. Often, elderly are excluded from trials because of multimorbidity or merely because of their age. Also, eligible patients should give informed consent for participation in a trial. This is complicated for patients that are not able to do this because of dementia or delirium. Additionally, in trials without age-limit, the numbers are often too small to draw conclusion in a subgroup of older patients. Besides, searching for geriatric information can be difficult, as geriatric information is published in a wide range of journals and not labelled consequently in databases. In this symposium, we aim to highlight several issues in doing research with geriatric patients in order to increase their participation in trials. Also, we provide some tips and tricks in incorporating evidence-based medicine in research and daily practice. Outline of the symposium: the symposium will be chaired by dr. Sophia de Rooij. Each presentation will take 15-20 minutes, leaving 15-30 minutes for general discussion: -what's different about older people? - Key issues in the conduct and reporting of RCTs - addressing comorbidity, frailty, cognition; - search filters for geriatric medicine; - creating evidence from individual patient data; - improving assessment and management of multimorbid elderly in clinical practice; - general discussion. Short information on the authors: David Stott holds the David Cargill Chair of Geriatric Medicine at the University of Glasgow. He is in the lead of the Cochrane Health Care in Older People's Field. A major emphasis in his current research program is prediction and prevention of late-life cerebrovascular disease and the associated cognitive decline and disability. His research program relies on extensive collaborative links, including with biostatistics (the Robertson Centre), clinical biochemistry and haemostasis at the University of Glasgow, nursing and the professions allied to medicine and with other academic centres of Geriatric Medicine in the UK, the Netherlands and Australia. Furthermore, he contributes actively to both undergraduate and postgraduate teaching and acts as supervisor/advisor for many PhD-students, MScs and MDs. Esther van de Glind is a resident for geriatrics. In 2010, she started her PhD project at the Academic Medical Center (AMC) in Amsterdam with working title: "Evidence-based medicine in geriatrics". This project aims to improve evidence-based medicine in clinical geriatric practice. Part of this is to investigate what is known already and to make evidence better available for the clinician. Lotty Hooft is a clinical epidemiologist, working as a scientific staff member (assistant professor) at the Dutch Cochrane Centre at the AMC, since October 2003. Her focus of research is on improving methodology, report and implementation of results of systematic reviews, including systematic reviews of diagnostic test accuracy. She is also the director of the trial register in the Netherlands and chair of the WHO Best Practice Working Group of the International Clinical Trials Registry Platform (ICTRP). Gunnar Akner is professor in Geriatric Medicine at Orebro University in Sweden and senior consultant geriatrician. He has been involved in clinical research in frail and multimorbid elderly for many years, focusing on overview and integrated management regarding medical drugs, nutrition, physical function/activity, technical aids and ADL-support. He has been the president of Swedish Society for Geriatric Medicine 2000-2005 and Swedish Society for Clinical Nutrition 2006-2011. He was chairman and editor for a systematic review of scientific treatment studies of people 65 years and older published 2003 by the Swedish Council on Health Technology Assessment (http://sbu.se/en/Published/Vit/Geriatriccare- and-treatment/).