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A JAMA THEME ISSUE Edited by Margaret A. Winker, MD, and Catherine D. DeAngelis, MD, MPH
Treatment of Alzheimer disease (AD) and prediction of 6-month survival among patients with dementia were the focus of 2 investigations reported in this issue. In a randomized trial of patients with mild to moderate Alzheimer disease, Quinn and colleagues Article assessed whether supplementation with docosahexaenoic acid (DHA)—an omega-3 fatty acid prominent in the brain and identified as a potential treatment for Alzheimer disease—would slow Alzheimer disease–related cognitive and functional decline. Patients received DHA or placebo for 18 months. The authors found no beneficial effect of DHA supplementation. In a prospective cohort study, Mitchell and colleagues Article assessed the performance of the Advanced Dementia Prognostic Tool (ADEPT) and Medicare hospice eligibility guidelines to estimate 6-month survival among nursing home residents with advanced dementia. The authors found that the ADEPT score demonstrated modest ability to identify nursing home residents with advanced dementia at high risk of 6-month mortality—performing somewhat better than the Medicare hospice eligibility guidelines. In an editorial, Yaffe Article discusses challenges in the treatment of Alzheimer disease and prognostication of dementia.
Gill and colleagues analyzed data from a longitudinal study that involved 754 community-dwelling persons aged 70 years or older who were initially nondisabled in 4 activities of daily living and who completed monthly telephone interviews. Transitions to disability or death were evaluated each month. The authors found that persons with intervening illnesses and injuries that led to hospitalization or activity restriction had an increased likelihood of developing new or worsening disability, particularly among those who were physically frail.
In a study conducted at 4 urban US hospitals, Dykes and colleagues investigated whether a fall prevention tool kit—that includes a fall risk assessment and generates a patient-specific fall prevention care plan, an over-the-bed poster, and a patient handout—would decrease the rate of patient falls in hospitals. Two acute care medical units—with similar fall rates and patient-days—at each hospital were randomly assigned to receive the intervention or to continue usual fall prevention efforts. The authors report that use of the fall prevention tool kit was associated with a significant reduction in the number of patients with falls.
Ms N is a 77-year-old woman with multiple health problems including hypertension and left ventricular hypertrophy, peripheral vascular disease with a below-knee amputation, chronic obstructive pulmonary disease, glaucoma, osteoarthritis, and degenerative intervertebral disk disease. Boult and Wieland Article discuss programs designed to integrate and improve the primary care of older, community-dwelling patients with multiple chronic conditions. Readers may submit comments for online posting at www.jama.com. A commentary by Chattopadhyay and Bindman Article discusses managed care demonstration programs for elderly persons who are eligible for both Medicare and Medicaid, which link comprehensive payment with comprehensive primary care and social services.
“I’ve learned from many patients and their families that accepting palliative care over invasive surgery for end-stage disease is not an epiphany but a process that takes time, information, and trusting relationships.” From “A Murmur of Music.”
Three articles highlight issues relevant to elderly patients: promoting safely controlling chronic pain, screening for driving impairments, and weighing implications of a study on CSF biomarkers of Alzheimer disease.
Maximizing potential of an aging population
A new approach to surrogate decision making
AND AUTHOR INTERVIEW
Age disparities in heart failure research
Aging: Preserving function, improving care
Join Michael A. Steinman, MD, Wednesday, November 17, from 2 to 3 PM eastern time to discuss managing medications for elders with clinically complex medical conditions. To register, go to www.ihi.org/AuthorintheRoom.
For your patients: Information about dementia.
This Week in JAMA . JAMA. 2010;304(17):1869. doi:10.1001/jama.2010.1594