Geriatric medicine

doi:10.1136/bmj.322.7278.86

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Sharon E Straus, geriatrician (sstraus@mtsinai.on.ca)

Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5

The number of people older than 65 years is increasing, and the proportion of people older than 85 is increasing exponentially. 1 2 In response to this challenge, clinicians need to assess and optimise health care for this group.

Methods

I reviewed the contents of ACP Journal Club and Evidence Based Medicine from 1998 to 2000 and, after discussion with colleagues, selected articles that I believed to be relevant to the care of geriatric patients. It is not possible to give a comprehensive review of all recent advances here, but additional articles are listed on the BMJ's website.

Cardiovascular risk

Several studies have shown the benefits of angiotensin converting enzyme inhibitors in patients with left ventricular dysfunction, but the findings of the heart outcomes prevention evaluation study provide evidence for the use of ramipril in patients at high risk of cardiac events who do not have left ventricular dysfunction. Treatment with ramipril decreased the risk of death (number needed to treat 56, 95% confidence interval 32 to 195), myocardial infarction (42, 27 to 89), and stroke (67, 43 to 145) compared with placebo.3

Cholesterol

A subgroup analysis of data on patients older than 65 from the cholesterol and recurrent events trial has been published recently.4 The study was a randomised, double blind, placebo controlled trial in which patients with a recent history of myocardial infarction and average cholesterol concentrations were allocated to either pravastatin 40 mg/day or placebo and subsequently followed for the development of major coronary events. Among the 1283 patients aged between 65 and 75 years, those randomised to pravastatin had reduced risks of major coronary events (number needed to treat 11, 95% confidence interval 8 to 24) and stroke (34, 22 to 333) at a median follow up of five years compared with patients who received placebo.4 …