The edition · Geriatrics
A Canadian guideline says keep statins in older adults unless they are near the end of life
GRADE-based deprescribing guidance rejects stopping statins on age alone; four in ten older adults return to the emergency department within a year of a fall; bed and chair alarms do not prevent inpatient falls; and one in three Indians studied had sarcopenia.
The edition in brief
Five findings for geriatricians and the GPs caring for older adults. A GRADE-based Canadian guideline on statin deprescribing for adults aged 65 or older suggests stopping statins at the end of life, continuing them for both primary and secondary prevention otherwise, and offering selected patients a conversation about stopping. A meta-analysis of 19 studies found that after a fall-related emergency department visit, 15.0% of older adults returned within 30 days and 41.3% within a year, with 10.4% readmitted within 30 days. A meta-analysis of randomised trials found mobilisation alarms did not reduce inpatient falls (IRR 0.93, 95% CI 0.83-1.04) or injurious falls (IRR 1.00), with prospectively registered studies least likely to report benefit. Among 192,118 US nursing home residents with a recent fracture, 72.8% were taking a drug linked to injurious falls but only 4.2% an oral bisphosphonate. A meta-analysis of 44 Indian studies found pooled confirmed sarcopenia of 35.4%, with only about half the studies using consensus definitions. A Dutch trial of topical pilocarpine drops for xerostomia in frail or seriously ill adults did not show a significant benefit over placebo, but was underpowered.
After a fall-related ED visit, 15% of older adults return within 30 days and 41% within a year
Do not discharge an older adult after a fall without arranging prompt follow-up and a falls assessment; four in ten return within a year.
Bed and chair alarms did not prevent falls in hospital
Stop using routine bed and chair alarms as a falls prevention strategy; randomised evidence shows no reduction in falls or injuries.
After a fracture, 73% of nursing home residents took a fall-risk drug and 4% a bisphosphonate
After a fracture in a care home resident, start bone protection and review opioids and anticonvulsants rather than doing neither.
One in three Indians studied had sarcopenia, measured many different ways
Screen older Indian patients for sarcopenia with grip strength or chair stands, using Asian Working Group criteria.
Pilocarpine drops did not beat placebo for dry mouth in frail patients, in an underpowered trial
For dry mouth in frail patients, start with medication review and mouth care; pilocarpine drops are an option without proven benefit.
Five chair stands tell you more than a BMI
Time five chair stands in older patients; 12 seconds or more suggests probable sarcopenia and a need for strength work.
Statin deprescribing guideline: continue in older adults for primary and secondary prevention unless at the end of life
Keep older adults on statins for primary or secondary prevention unless they are near the end of life, and discuss stopping only with selected patients.
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