Cancer Prevention and Screening for Older Adults

Journal of the American Geriatrics Society Research Summary

Improved cancer screening and treatment, along with much lower rates of tobacco use, have led to a decrease in cancer diagnoses and deaths. However, because the risk for many cancers increases as people age, it is still the second most common cause of death in older adults after heart disease.

Cancer prevention is important for older adults in order to reduce deaths and prevent the poor quality of life that can be caused by advanced cancer and treatment side effects. Efforts focus on preventing cancer as well as identifying the disease in its early stages by using screening tests. When someone is diagnosed with an early-stage cancer, they are likely to require less extensive treatment and have a better chance for recovery.

Recently, a research team offered new information and guidance for healthcare providers about cancer screening and prevention for older adults. They published their guidance in the Journal of the American Geriatrics Society. According to the researchers, healthcare practitioners need to fully understand how a particular cancer will impact an older adult. They also need to consider the effectiveness, drawbacks, and expense of cancer prevention and screening. Finally, health care practitioners need to understand how well a person will fare—with and without cancer treatment—when they discuss cancer screening with older adults. Continue reading

Should Diabetes Treatment Lessen for Older Adults Approaching the End of Life?

Journal of the American Geriatrics Society Research Summary

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One in four people aged 65 or older has diabetes. The disease is the seventh leading cause of death in the United States and a major contributor to heart disease. Experts have recommended that the best way to slow the progression of diabetes—and help prevent its many complications—is to maintain strict control of blood sugar levels. For healthy younger people, this means keeping the target blood sugar level (known as A1c or HbA1c) lower than 6.5 percent to 7.0 percent.

For older adults who have a limited life expectancy or who have advanced dementia, however, maintaining that target blood sugar level may cause more harm than good. For example, these older adults may not live long enough to experience potential benefits. What’s more, maintaining these strict blood sugar levels can raise the risk of potentially harmful events such as low blood sugar (also known as hypoglycemia). This can cause falls or loss of consciousness.

For these reasons, many guidelines now suggest targeting higher HbA1c targets—such as between 8.0 percent and 9.0 percent—for older adults who have multiple chronic conditions or limited life expectancy, or who live in nursing homes.

There is not much existing research to guide health care practitioners as to what the appropriate levels of diabetes medications are for this group of older adults. There is also little information about the effects for these individuals of taking fewer or lower dose of diabetes medications.

Experts suspect that lessening diabetes treatment in these older adults has the potential to prevent unnecessary hospitalizations due to lowering the risk for harmful drug events and increasing the patients’ comfort.

In order to investigate the issue, a team of researchers conducted a study—one of the first national studies to examine potential overtreatment and deintensification of diabetes management in nursing home residents with limited life expectancy or dementia. The researchers chose nursing home residents to study because admission to a nursing home could give healthcare practitioners a chance to learn more about patient goals and preferences and to review and adjust medications accordingly. The researchers published their results in the Journal of the American Geriatrics Society. Continue reading