Download or read book Clinical Trials in Older Adults written by Antonio Cherubini and published by John Wiley & Sons. This book was released on 2016-01-13 with total page 280 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical Trials in Older Adults is the first book to consider the methodological issues underlying the evaluation of new treatments in older people. Provides information on the methodology, monitoring and regulations for those planning to conduct a clinical trials involving older adults Contains examples of ongoing trials involving older adults, and presents the main characteristics of many recently published Depicts how the issues regarding older adults in clinical trials could be properly addressed with the appropriate study design and conduct Identifies key issues in performing clinical trials in older patients with common geriatric conditions, i.e. Alzheimer’s dementia, depression, low muscle mass, cancer

Download or read book Pathy s Principles and Practice of Geriatric Medicine written by Alan J. Sinclair and published by John Wiley & Sons. This book was released on 2012-03-13 with total page 3453 pages. Available in PDF, EPUB and Kindle. Book excerpt: This new edition of the comprehensive and renowned textbook Principles and Practice of Geriatric Medicine offers a fully revised and updated review of geriatric medicine. It covers the full spectrum of the subject, features 41 new chapters, and provides up-to-date, evidence-based, and practical information about the varied medical problems of ageing citizens. The three editors, from UK, USA and France, have ensured that updated chapters provide a global perspective of geriatric medicine, as well as reflect the changes in treatment options and medical conditions which have emerged since publication of the 4th edition in 2006. The book includes expanded sections on acute stroke, dementia, cardiovascular disease, and respiratory diseases, and features a new section on end-of-life care. In the tradition of previous editions, this all-encompassing text continues to be a must-have text for all clinicians who deal with older people, particularly geriatric medical specialists, gerontologists, researchers, and general practitioners. This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from Google Play or the MedHand Store. Praise for the 4th edition: "...an excellent reference for learners at all clinical and preclinical levels and a useful contribution to the geriatric medical literature." —Journal of the American Medical Association, November 2006 5th edition selected for 2012 Edition of Doody's Core TitlesTM

Download or read book Cancer and Aging written by M. Extermann and published by Karger Medical and Scientific Publishers. This book was released on 2013-01-18 with total page 179 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer is clearly an age-related disease. Recent research in both aging and cancer has demonstrated the complex interaction between the two phenomena. This affects a wide spectrum of research and practice, anywhere from basic research to health care organization. Core examples of these close associations are addressed in this book. Starting with basic research, the first chapters cover cancer development, mTOR inhibition, senescent cells altering the tumor microenvironment, and immune senescence affecting cancer vaccine response. Taking into account the multidisciplinarity of geriatric oncology, several chapters focus on geriatric and oncologic aspects in patient assessment, treatment options, nursing and exercise programs. The book is rounded off by a discussion on the impact of the metabolic syndrome illustrating the interactions between comorbidity and cancer and a chapter on frailty.This book provides the reader with insights that will hopefully foster his or her reflection in their own research and practice to further the development of this most exciting field. Given the aging of the population worldwide and the high prevalence of cancer, it is essential reading not only for oncologists and geriatricians but for all health practitioners.

Download or read book Investing in Clinical Trials for Older Adults written by Woojung Lee and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Conducting clinical trials for older adults can address the long-standing issue of the underrepresentation of older adults and the lack of clinical evidence for them. Examining the challenges and the value of such trials could facilitate discussion among trial sponsors on the investment in and the prioritization of older adult-specific trials. This dissertation examines the risk of failure and the real-world value of older adult-specific clinical trials. In Chapter 1, we developed a model that predicts the risk of failure of older adult-specific cancer clinical trials, using trial-level factors. The best-performing machine learning model had an acceptable performance and included nine trial-level factors that can be measured using the trial protocol. The model can aid in the design and prioritization of future older adult-specific clinical trials. Future works examining the causal relationship between the important factors the trial failure can help develop strategies to reduce the risk of failure of cancer trials for older adults. In Chapter 2, we estimated the impact of cumulative evidence from older adult-specific trials on the prescribing patterns, using phase 3 clinical trials for post-lumpectomy irradiation in early-stage breast cancer (ESBC) as a case study. The difference-in-differences analysis showed that older adult-specific trial results led to a significant decrease in irradiation use over time among older adults and the rate of decrease was significantly accelerated by longer-term follow-up results. These findings confirm the potential of new evidence for older adults to make a substantial change in providers’ prescription patterns and the importance of evidence accumulation in driving their behavioral change. Chapter 3 builds on this analysis to quantify the downstream clinical and economic benefits of older adult-specific trial results, using a health-transition model. We found that the older adult-specific trial results on the post-lumpectomy irradiation in ESBC resulted in a substantial cost-saving in the US society, without significantly changing clinical outcomes. These results can inform the discussion around whether to invest in older adult-specific clinical trials. More case studies for trials with different types of results are warranted to have a more comprehensive understanding of how different types of older adult-specific trials generate value.

Download or read book The Prevention and Treatment of Missing Data in Clinical Trials written by National Research Council and published by National Academies Press. This book was released on 2010-12-21 with total page 163 pages. Available in PDF, EPUB and Kindle. Book excerpt: Randomized clinical trials are the primary tool for evaluating new medical interventions. Randomization provides for a fair comparison between treatment and control groups, balancing out, on average, distributions of known and unknown factors among the participants. Unfortunately, these studies often lack a substantial percentage of data. This missing data reduces the benefit provided by the randomization and introduces potential biases in the comparison of the treatment groups. Missing data can arise for a variety of reasons, including the inability or unwillingness of participants to meet appointments for evaluation. And in some studies, some or all of data collection ceases when participants discontinue study treatment. Existing guidelines for the design and conduct of clinical trials, and the analysis of the resulting data, provide only limited advice on how to handle missing data. Thus, approaches to the analysis of data with an appreciable amount of missing values tend to be ad hoc and variable. The Prevention and Treatment of Missing Data in Clinical Trials concludes that a more principled approach to design and analysis in the presence of missing data is both needed and possible. Such an approach needs to focus on two critical elements: (1) careful design and conduct to limit the amount and impact of missing data and (2) analysis that makes full use of information on all randomized participants and is based on careful attention to the assumptions about the nature of the missing data underlying estimates of treatment effects. In addition to the highest priority recommendations, the book offers more detailed recommendations on the conduct of clinical trials and techniques for analysis of trial data.

Download or read book Clinical Trials and Older Adults written by and published by . This book was released on 2019 with total page 19 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Drug Research and Development for Adults Across the Older Age Span written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-10-22 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: There is a void in evidence-based information for making informed decisions on how to optimize care for older adults, particularly those 80 years and over. Because older adults are vastly underrepresented in clinical trials, there is a dearth of information about the appropriate use of drugs in this population. Yet older adults have higher rates of comorbidities and simultaneous use of multiple medications than the general population, and are the majority users of many medications. Additionally, age-related physiological and pathological changes, particularly for adults 80 years of age and older, can lead to significant differences in the pharmacokinetics (PK)2 and pharmacodynamics (PD)3 of a given drug compared to the general population. On August 5 and 6, 2020, the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Drug Research and Development for Adults Across the Older Age Span. The workshop was designed to examine the challenges and opportunities in drug research and development for older adult populations, explore barriers that impede safety and efficacy studies in these populations, and share lessons learned for better understanding clinical pharmacology for populations over age 65. This publication summarizes the presentation and discussion of the workshop.

Download or read book Delivering High Quality Cancer Care written by Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population and published by National Academies Press. This book was released on 2014-01-10 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

Download or read book Social Isolation and Loneliness in Older Adults written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-05-14 with total page 317 pages. Available in PDF, EPUB and Kindle. Book excerpt: Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Download or read book Geriatric Medicine written by Frank Lally and published by Oxford University Press, USA. This book was released on 2014 with total page 237 pages. Available in PDF, EPUB and Kindle. Book excerpt: People are living longer and the population over the age of 60 is burgeoning, with repercussions for health services and healthcare expenditure in developed countries. Crucially, disease aetiology, diagnosis, and treatment in older people differ from the general adult population. Older people often have complicated co-morbidities and respond to treatment in different ways compared to younger people. Evidence of efficacy of different treatments is often lacking because older people are under-represented in clinical trials, and the specific needs of older people are rarely discussed specifically in more general texts. Geriatric medicine: an evidence based approach is a clinical reference for health care professionals who manage older patients, and summarizes up-to-date research literature in a style that can be directly applied by busy healthcare professionals and provide a useful resource for reference.

Download or read book Retooling for an Aging America written by Institute of Medicine and published by National Academies Press. This book was released on 2008-08-27 with total page 316 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.

Download or read book Contemporary Perspectives on Ageism written by Liat Ayalon and published by Springer. This book was released on 2018-05-22 with total page 582 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book provides a comprehensive perspective on the concept of ageism, its origins, the manifestation and consequences of ageism, as well as ways to respond to and research ageism. The book represents a collaborative effort of researchers from over 20 countries and a variety of disciplines, including, psychology, sociology, gerontology, geriatrics, pharmacology, law, geography, design, engineering, policy and media studies. The contributors have collaborated to produce a truly stimulating and educating book on ageism which brings a clear overview of the state of the art in the field. The book serves as a catalyst to generate research, policy and public interest in the field of ageism and to reconstruct the image of old age and will be of interest to researchers and students in gerontology and geriatrics.

Download or read book Aging Research Methodological Issues written by Carmen García-Peña and published by Springer. This book was released on 2018-09-25 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is the second edition of a well received book that reviews classical epidemiological and clinical research designs, with a specific focus on aging. Chapters cover basic topics like the scientific method, ethics, and the consequences of certain exclusion criteria. The work also includes a look at clinical concepts like multimorbidity, frailty and functionality. New material includes chapters such as geroscience, health systems research, big data and data mining, financing and future of aging research. The authors reveal the issues and challenges for researchers of age and aging, and also consider, from basic to clinical, and from clinical to public policies of social and health care. The focus on aging is what gives this book its valuable perspective on research methodology. All authors have considerable experience in aging, geriatrics or gerontology, and each chapter includes both a theoretical framework and practical examples of studies in aging. Readers will discover study designs that are reviewed for basic structure, main flaws and advantages, and are analyzed for specific conditions and variables regarding aging. This text is suited to both health care professionals caring for older adults, and researchers who are new to research in aging. It is relevant across the disciplines, including medicine, psychology, social sciences and dentistry, and it supports learning with graphs and figures.

Download or read book Adherence to Behavioral and Pharmacological Interventions in Clinical Research on Older Adults written by Sally A. Shumaker and published by . This book was released on 2000 with total page 91 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Elderhood written by Louise Aronson and published by Bloomsbury Publishing USA. This book was released on 2019-06-11 with total page 467 pages. Available in PDF, EPUB and Kindle. Book excerpt: Finalist for the Pulitzer Prize in General Nonfiction A New York Times Bestseller Longlisted for the Andrew Carnegie Medal for Excellence in Nonfiction Winner of the WSU AOS Bonner Book Award Winner of the 2022 At Home With Growing Older Impact Award As revelatory as Atul Gawande's Being Mortal, physician and award-winning author Louise Aronson's Elderhood is an essential, empathetic look at a vital but often disparaged stage of life. For more than 5,000 years, "old" has been defined as beginning between the ages of 60 and 70. That means most people alive today will spend more years in elderhood than in childhood, and many will be elders for 40 years or more. Yet at the very moment that humans are living longer than ever before, we've made old age into a disease, a condition to be dreaded, denigrated, neglected, and denied. Reminiscent of Oliver Sacks, noted Harvard-trained geriatrician Louise Aronson uses stories from her quarter century of caring for patients, and draws from history, science, literature, popular culture, and her own life to weave a vision of old age that's neither nightmare nor utopian fantasy--a vision full of joy, wonder, frustration, outrage, and hope about aging, medicine, and humanity itself. Elderhood is for anyone who is, in the author's own words, "an aging, i.e., still-breathing human being."

Download or read book Transforming Clinical Research in the United States written by Institute of Medicine and published by National Academies Press. This book was released on 2010-10-22 with total page 151 pages. Available in PDF, EPUB and Kindle. Book excerpt: An ideal health care system relies on efficiently generating timely, accurate evidence to deliver on its promise of diminishing the divide between clinical practice and research. There are growing indications, however, that the current health care system and the clinical research that guides medical decisions in the United States falls far short of this vision. The process of generating medical evidence through clinical trials in the United States is expensive and lengthy, includes a number of regulatory hurdles, and is based on a limited infrastructure. The link between clinical research and medical progress is also frequently misunderstood or unsupported by both patients and providers. The focus of clinical research changes as diseases emerge and new treatments create cures for old conditions. As diseases evolve, the ultimate goal remains to speed new and improved medical treatments to patients throughout the world. To keep pace with rapidly changing health care demands, clinical research resources need to be organized and on hand to address the numerous health care questions that continually emerge. Improving the overall capacity of the clinical research enterprise will depend on ensuring that there is an adequate infrastructure in place to support the investigators who conduct research, the patients with real diseases who volunteer to participate in experimental research, and the institutions that organize and carry out the trials. To address these issues and better understand the current state of clinical research in the United States, the Institute of Medicine's (IOM) Forum on Drug Discovery, Development, and Translation held a 2-day workshop entitled Transforming Clinical Research in the United States. The workshop, summarized in this volume, laid the foundation for a broader initiative of the Forum addressing different aspects of clinical research. Future Forum plans include further examining regulatory, administrative, and structural barriers to the effective conduct of clinical research; developing a vision for a stable, continuously funded clinical research infrastructure in the United States; and considering strategies and collaborative activities to facilitate more robust public engagement in the clinical research enterprise.

Download or read book Management of Breast Cancer in Older Women written by Malcolm W. Reed and published by Springer Science & Business Media. This book was released on 2010-01-18 with total page 408 pages. Available in PDF, EPUB and Kindle. Book excerpt: I was looking at Mrs T – all 45 kilos of her – with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, “because it was making her tired.” As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T’s kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? “Physicians,” said Voltaire, “pour drugs they know little for diseases they know even less into patients they know no- ing about.” Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.