ABSTRACT
The rate of college student mental health difficulties has been climbing, leading to overburdened college counseling centers. We propose the Holistic Prevention & Intervention Model (HPIM) as one solution in which campus and community resources work collaboratively to support students experiencing psychological distress and alleviate clinical demands. The HPIM moves from autonomous solutions to organizational-based strategies on a continuum of proactive to reactive interventions. We discuss how this model can be tailored and implemented for college campuses across the United States, including examining the resources available to the campus, the overall campus culture, and college demographics that affect risk and protective factors.
ABSTRACT
Up-dated recommendations published in 2019 about inappropriate medications in older persons and management for type 2 diabetes mellitus are discussed. New evidence has also been published regarding the benefits of physical activity in secondary prevention for falls as well as in the prevention of cognitive decline and dementia, independent of genetic and vascular risk profile. SPRINT MIND study reports a significant 19â % decreased risk of minor neurocognitive impairment with intensive BP treatment. A meta-analysis about prevention of delirium with antipsychotics report benefits only in cardiac and orthopedic post-operative settings, whereas another meta-analysis about delirium treatment did not find any benefits from antipsychotics.
Les mises à jour 2019 des critères de Beers (médicaments à éviter chez les personnes âgées) et des recommandations pour le traitement du diabète de type 2 sont résumées. De nouvelles études renforcent les évidences concernant les bénéfices de l'activité physique en prévention secondaire des chutes, mais aussi pour ralentir le déclin cognitif et réduire le risque de démence, indépendamment du risque génétique ou vasculaire. L'étude SPRINT MIND rapporte une réduction de 19â % de l'incidence des troubles neurocognitifs mineurs sous traitement HTA intensif. Finalement, une méta-analyse concernant la prévention pharmacologique de l'état confusionnel aigu (ECA) suggère une efficacité des neuroleptiques limitée aux situations post-chirurgie cardiaque et orthopédique, alors qu'une autre concernant le traitement de l'ECA nous laisse sur notre faim.
Subject(s)
Antipsychotic Agents , Delirium , Dementia , Diabetes Mellitus, Type 2 , Geriatrics , Aged , Aged, 80 and over , Geriatrics/trends , Humans , Meta-Analysis as TopicABSTRACT
In 2018, new recommendations about the prevention of falls and fractures emphasized the benefits from exercise and from multimodal prevention programs but did not endorse any more vitamin D supplementation for falls prevention. Results were contrasted for several studies testing exercise (negative) and cognitive training (mixed results) in the management of older patients suffering from neurocognitive disorders. The new direct oral anticoagulants are increasingly prescribed in older patients despite the paucity of data. New information has been released in 2018 from « real-world ¼ data that seem reassuring about their risk/benefit ratio in old-old patients, provided a careful prescription. Finally, the Mediterranean diet is still gaining credit with a new study showing its benefits in preventing frailty in community-dwelling older persons.
En 2018, l'intérêt de l'activité physique et des programmes de prévention multimodaux est confirmé pour la prévention des chutes, mais l'utilisation de la vitamine D dans cette indication est remise en question. Pour les pathologies neurocognitives, les résultats sont contrastés concernant l'activité physique, alors qu'une revue systématique confirme les bénéfices, certes modestes, de l'entraînement cognitif sur les performances cognitives et la qualité de vie des patients et de leurs proches. Les nouveaux anticoagulants sont de plus en plus largement utilisés chez les patients âgés malgré des données encore limitées, mais plusieurs études du « monde réel ¼ semblent confirmer leur bon rapport risques/bénéfices aussi chez ces patients. Le régime méditerranéen a le vent en poupe, une étude rapporte un bénéfice sur l'incidence de la fragilité.
Subject(s)
Accidental Falls , Fractures, Bone , Geriatrics , Accidental Falls/prevention & control , Aged , Exercise , Fractures, Bone/prevention & control , Geriatrics/trends , Humans , Independent Living , Vitamin DABSTRACT
Over the last few years, we have noticed the arrival on the market of new antidiabetic treatments. These represent an potential advantage because of the increase in the prevalence of type 2 diabetes, particularly in the elderly population. Nevertheless, elderly patients have a number of frailties that should be considered in the treatment of this condition. There is a lack of literature in this population as elderly are frequently excluded from randomized controlled trials. Therefore, guidelines were developed based on the consensus of experts in geriatrics and diabetology for this specific population. We have to consider the potential benefits and adverse effects of the new antidiabetics in older patients.