The edition · Geriatrics
Fit over-70s did as well as younger patients on intensive gastric cancer treatment
A TOPGEAR analysis argues against age alone as a reason to withhold curative therapy, an Indian deprescribing trial maps why stopping fall-risk drugs is hard, and frailty clusters carry the clearest mortality signal.
The edition in brief
In the phase 3 TOPGEAR trial, the 135 patients aged 70 or over with resectable gastric cancer needed more chemotherapy modifications and had more blood toxicity and diarrhoea than younger patients, but had similar surgical outcomes and survival (overall survival HR 0.75-0.86, intervals crossing 1). The DeFRID trial team in India describe four groups of barriers to deprescribing fall risk-increasing drugs: clinical equipoise, recruitment and retention, measuring falls, and local factors such as normalised polypharmacy and hierarchical decision-making. In 16,095 ASPREE participants over 70, a cluster of frailty, depressive symptoms and osteoporosis was associated with higher mortality in both sexes, as was a gout, anaemia and kidney cluster in women (HR 1.96). A meta-analysis of 31 trials found tai chi and Baduanjin improved balance and fall-risk test scores, without evidence on actual falls. Older Australians using prescribed opioids had markedly lower quality of life after adjustment. The pearl covers measuring postural blood pressure properly.
Why deprescribing fall-risk drugs stalls - lessons from an Indian trial
Treat a fall as a prompt to review every fall-risk drug, including those another doctor started, and plan reductions with the patient.
Frailty, depression and osteoporosis formed the deadliest multimorbidity cluster
Frailty with depressive symptoms and osteoporosis marked the highest-risk multimorbidity pattern in over-70s; screen for depression when you see the other two.
Tai chi and Baduanjin improved balance scores in older adults
Tai chi and Baduanjin are reasonable balance options for older adults, though this analysis did not measure falls.
Prescribed opioids linked to much lower quality of life in older Australians
Treat long-term opioid use in an older person as a prompt to review function, pain and continuing benefit.
Measure postural blood pressure the way that finds it
Measure postural blood pressure after five minutes lying and at one and three minutes standing in every older person who falls.
Over-70s with gastric cancer did as well as younger patients on perioperative therapy
For a fit older adult with resectable gastric cancer, age alone should not rule out perioperative treatment; plan for dose modification and toxicity support.
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