Wednesday, November 2, 2005
The current J of the American Geriatrics Society has a couple of articles of note. First is a randomized, double-blind, placebo-controlled cross-over trial of acetaminophen (1000mg tid, scheduled, for an entire month) vs placebo to evaluate its effects on the behavior of those with advanced dementia. To their credit, the investigators used prospectively gathered data on behaviors (things like "direct social involvement,"unattended distress," etc.). 20-some behaviors were measured, and, despite a few of them being significantly but minimally improved (media-time, independent self-care, direct social involvement) for the most part it was a wash & I'm not convinced the few significantly different measures were anything other than noise. Agitation or psychotropic med use weren't changed either. It's too bad...chronic, moderate dose APAP use is generally so benign that even moderate improvements would have a good risk-benefit profile.
There's also a lengthy look at breast cancer in alzheimer's disease patients , using data from a national registry. It confirms what most would have guessed: it's diagnosed at later stages, and demented patients receive less cancer-directed treatment (less chemo, radiation, and mastectomy--but interestingly more breast-conserving surgery). What they don't report on however is hormonal treatment use (due to the nature of the database used) which is too bad since, compared to chemo/xrt/scalpel, hormonal therapy is much more benign & would presumably be acceptable to many patients/families to whom the other therapies wouldn't.
Finally, there's a survey suggesting that bereaved families' perceptions of quality of end of life care is lower in areas with a higher intensity of medical services (more ICU's etc.), but it seems to me that this difference cannot be blamed on ICU's per se, as suggested in the paper's title.