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Age ain't nothing but a number

Ami Banerjee
Last edited 14th September 2012

Yesterday’s news hero was 100-year old Fauja Singh who finished the Toronto Waterfront Marathon to enter the Guiness Book of Records as the oldest man to ever complete a marathon. After reading so much about obesity, lifestyle risk factors and the chronic disease epidemic, it is great to hear that this Sikh gentleman has reached his age and maintained his fitness by sticking to ginger curry and tea.

Age and the “elixir of life” seem to be the theme of the news this week. Scientists fully decoded the genome of the world’s oldest woman who died in 2004 at the age of 115 years. This lady had no signs of dementia whatsoever and her good health has led to hopes that her genome will provide clues to her longevity. A herring-rich diet may have had something to do with it.

Ageing research is big money and a big priority. At the National Institutes of Health (NIH), over US$2.5 billion will be spent on ageing research this year, and the UK has been strengthening its ageing research portfolio and networks for the past few years. Scientific journals have blossomed around the search for life-prolonging knowledge. Did you know there was a journal called “Rejuvenation Research” ?

In clinical trials and research studies, if a difference is detected between two groups of individuals, often the first step in analysis is to “adjust for age”. In plain English, that means if we get rid of the differences between two groups which are just caused by differences in the ages of the individuals in the two groups, then we can assess if there are any other differences. It has always seemed counterintuitive to me that we do not also routinely adjust for sex, ethnicity, education, socioeconomic status and any number of other risk factors which can cause differences between groups of people.

With the make-up of our societies shifting more in the direction of elderly populations with increasing chronic diseases, the focus of research is shifting to how age itself contributes to disease processes and how we might reverse age-related processes. But are we focusing too much on just one factor? Age is undoubtedly a major contributor to many diseases and their underlying development but we cannot look at age in isolation. Fauja Singh and other healthy ageing adults reach their old age due to the complex interactions between genes, environment and chance, like every disease that medical science has so far uncovered. So to just look at his genes for the answer or for everybody to start on a diet of ginger curry does not make sense to me.

Think about this? There is only one speciality where the patient isn’t discharged from the doctor’s care. The answer is general practice. Yet in most clinical jobs, the all important discharge, is the most important outcome.

Once the patient has left then it’s not my problem: until the next time.

There is tentative evidence that Patient outcomes can be improved, if after discharge to home, they are visited by the doctor who treated them in hospital in the first place.

Yet, it’s slightly confusing, although communication between Primary care docs and hospital docs was found to be pretty poor at the time of discharge. There’ no surprise in that. In one study it made no difference in terms of adverse outcomes, if the communication was good or bad.

In addition to this, many patients leave hospital with test results pending and doctors are often unaware of important actions once the patient has gone home.

Even simple things can make a difference: The risk of being admitted to hospital decreases when patients are seen after discharge by a clinician who has actually received the discharge summary. Common sense at its best.

A lot of people want to know how to save healthcare costs and reform the health service. Then the answer has to be: ask simple questions and think simple answers. If everyone in healthcare stopped seeing discharge as the outcome we’d be a lot better off.

Evidence 2010

Carl Heneghan
Last edited 15th June 2010

Right now, you would have to have been asleep to not realize implementing cost-effective change based on evidence is the key challenge for health systems around the world. beciause this its the most pressing problem we decided to bring together a conference of the evidence creators and evidence users to define the processes for implementing best clinical practice and forging efficient and cost-effective solutions for healthcare.

We would like you to join us at Evidence 2010, the leading evidence-based healthcare event at the forefront of EBM debate and innovation.

The conference is a collaboration between the BMJ and the Centre for Evidence Based Medicine CEBM.

The aims of the conference are to:

* Improve evidence-based decision making and provide practical, evidence-based ideas that can be implemented in practice
* Foster effective innovation
* Guide efficient commissioning
* Provide education and training to improve evidence-based healthcare.

We've got some great speakers lined up including:
Jim Easton, Sir Iain Chalmers, Sir Muir Gray Victor Montori,
Paul Glasziou, Mike Clarke, Sharon Straus,
Giordano Perez Gaxiola, Steven Woloshin, Fiona Godlee, Bill Summerskill, Helen Lester, Rubin Minhas, Amanda Burls, Dan Lasserson, Dyfrig Hughes, Tony Rudd, Tim Ringrose, Tom Jefferson, Ann McPherson, and Fiona Fox
Oh and not to mention Ben Goldacre Bad Science.Net

Look forward to seeing you there, Carl

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