Acute pain management for older adults.

Older adults may experience a number of physiological changes that influence how acute pain is perceived, diagnosed and managed by healthcare professionals. Understanding these differences enables the identification, assessment and treatment of acute pain in older adults. Combining careful selection of pain medications with appropriate titration and monitoring allows the analgesic needs of this group to be met.

Physiological changes from ageing regarding pain perception and its impact on pain management for older adults.

Physiological changes that occur during ageing can affect the incidence, experience and treatment of pain in older adults. This article reviews these physiological changes and how they can affect the best approach to management.

Mirabegron in the Treatment of Overactive Bladder: Safety and Efficacy in the Very Elderly Patient.

Lower urinary tract symptoms, including urgency, urgency incontinence, frequency, and nocturia, are highly prevalent in older adults and are associated with significant morbidity and impairment in quality of life. When conservative measures such as bladder training fail to improve symptoms, pharmacological management is recommended by national and international guidelines. Mirabegron, an agonist of the ß3 adrenergic receptor, demonstrates similar efficacy to the anticholinergic drugs without the risk of anticholinergic effects, but experience and evidence in the very elderly population are limited. This narrative review examines the current evidence base for mirabegron in very elderly adults.

A systematic review of trends in the selective exclusion of older participant from randomised clinical trials.

INTRODUCTION: The unjustified exclusion of older participants from clinical trials creates research populations that are non-representative, in turn creating difficulties applying research to the target populations. The aim of this study was to assess the proportion of randomised control trials (RCTs) that have unexplained upper age limits and review whether this proportion is reducing over time. METHODS: All RCTs in BMJ, Lancet, JAMA and NEJM from 1998 to 2015 were reviewed to identify any specified upper-age cut off and, if so, whether this exclusion criterion had an explanation in the text. The proportion of RCTs with an unexplained cut off was then correlated over time to look for any changes. RESULTS: 5680 papers were identified and 1339 excluded as they did not meet the search criteria. Of the remaining 4341 RCTs, 1258 (29%) had upper age limits specified, 1168 (92.8%) of which did not have any explanation for this cut off, a total of 26.9% of the RCTs reviewed. Over the 18-year period there was limited but statistically significant decrease in the proportion of RCTs with unexplained upper age limits (Pearson Correlation -0.609, P valve 0.007). CONCLUSION: Despite being the highest consumers of medical interventions and medications, this review highlights that older patients remain under-represented in clinical trial with only modest improvements despite increasing awareness of the problem. Future research must continue to adapt to provide insight into the differential effects of medical treatments in older patients by ensuring that trial participants are representative of the patient population receiving the intended therapy.

Clinical applications of retinal gene therapy.

Many currently incurable forms of blindness affecting the retina have a genetic etiology and several others, such as those resulting from retinal vascular disturbances, respond to repeated, potentially indefinite administration of molecular based treatments. The recent clinical advances in retinal gene therapy have shown that viral vectors can deliver genes safely to the retina and the promising initial results from a number of clinical trials suggest that certain diseases may potentially be treatable. Gene therapy provides a means of expressing proteins within directly transduced cells with far greater efficacy than might be achieved by traditional systemic pharmacological approaches. Recent developments have demonstrated how vector gene expression may be regulated and further improvements to vector design have limited side effects and improved safety profiles. These recent steps have been most significant in bringing gene therapy into the mainstream of ophthalmology. Nevertheless translating retinal gene therapy from animal research into clinical trials is still a lengthy process, including complexities in human retinal diseases that have been difficult to model in the laboratory. The focus of this review is to summarize the genetic background of the most common retinal diseases, highlight current concepts of gene delivery technology, and relate those technologies to pre-clinical and clinical gene therapy studies.