UpdateInGeriatrics

Congratulations to Heather Bulley, Marie Migliarini, and Christine Lam-Au, our 2024 Clinical Excellence Award recipients. We appreciate your dedication to caring for our patients!

3 - No difference in long term outcomes between delayed vs immediate levadopa therapy for PD patients 4 - Gabapentinoids have a long list of side effects and should be prescribed with caution 5 - The earlier and longer we try to prevent dementia, the better

Bottom lines: 1 - Brexipiprazole is a new option for agitation in Alzheimer's, with caution as harm profile not yet clear. 2 - Patient preference is what matters most in NSTEMI care; no benefit for invasive vs conservative strategy.

Last but not least, Dr. Justin Lee of @MacDeptMed @GERAScentre will take us through the top five practice changing articles of 2024. We'll answer the following clinical questions:

Another great session by Dr. Zahra Goodarzi! We reviewed pharmacological and non-pharmacological management of the neuropsychiatric symptoms of dementia. Need practical, evidence based ideas to manage these symptoms? Dr. Goodarzi suggests you check out behavioursindementia.ca

Dr. Robert Butcher (PhD in Bioethics) walks us through the nuances of restraint use and capacity assessment in older adults -- minimizing harm, balancing perspectives, and advanced care planning. #MacGeriUpdate2024

A great resource for providers, patients and care partners: deliriumhelp.ca

Our 2nd keynote speaker, Dr. Karin Neufeld of @MacDeptMed & @MIRAMcMaster, reminds us of the risk factors, outcomes, and evidence in pharmacological and non-pharmacological management of delirium. Some take-home points re pharm and non-pharm strategies:

The bottom line: There is no evidence that surgery or anesthesia can cause cognitive change. BUT - there are still surgical risks for older adults. In those with post-op delirium or cognitive change, consider secondary causes such as stroke, coronary disease, pain, or infection.

Next, Dr. Elizabeth Whitlock @UCSF walked us through the evidence for cognitive outcomes after surgery. Many patients are fearful that anesthesia will cause functional or cognitive loss, with countless anecdotes like that of Dr. Cole's father: washingtonpost.com/national/healt…

We're back from break with an excellent talk by Dr. Sidhu about cannabis use in older adults. 🧠Potential indications may include chronic pain, agitation, and sleep 🧠Our understanding of nabilone vs plant based therapies is growing 🧠Consider cost, drug interactions, and safety

Other key points: 🔑Tau burden plays important role in effectiveness of anti-amyloid therapy 🔑Shared decision-making and thoughtful discussions needed for mAb therapy 🔑Currently, CSF or PET needed to ID biomarkers

Donanemab (TRAILBLAZER) - target insoluble amyloid plaques - q4wk infusion, duration depends on amyloid burden on PET - on iADRS, 2.92; on CDR-SB, 0.7 out of 18 difference - greater ARIA compared to Lecanemab

Dr. Esther Oh of @JohnsHopkinsDOM takes us through an informative update on the mAbs! ⬇️

Dr. David Tang-Wai teaches us how to systematically approach dementias with parkinsonism. ⭐️ Timing is key! ⭐️ Consider ALL differentials (PSP, CBD, MSA, DLB, IPD, vascular) from the start, instead of an "afterthought" of IPD. ⭐️ Characterize the motor and non-motor symptoms.

A great example of how multidisciplinary interventions have been implemented in one UK clinic, with a direct increase in hospital admissions amongst patients: chcpcic.org.uk/chcp-services/…

We started off our day with an excellent Keynote address by Dr. Clegg. Key message: We need to better translate evidence into routine practice for our frail older adults, particularly in primary care and among community dwelling patients.

Congratulations to our Lifelong Achievement Award recipient, Brenda Flaherty. Thank you for your outstanding contributions to health care in Hamilton.

Today's the day! Kicking it off with introductions and housekeeping at 8:45 AM.