Mirko Petrovic

Ghent University | UGhent · Geriatrics

Medication self-management problems such as the inability to correctly obtain, understand, organize, administer or monitor medication can result in negative patient outcomes. However, supportive tools for healthcare providers to assist patients with medication self-management problems are lacking. This study aimed to develop recommendations for hea...

Background: Data on non-vitamin K antagonist oral anticoagulant (NOAC) use in patients with atrial fibrillation (AF) and a history of falls are limited. Therefore, we investigated the impact of a history of falls on AF-related outcomes, and the benefit-risk profiles of NOACs in patients with a history of falls. Methods: Using Belgian nationwide dat...

Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In PubMed and Web of Science we screened studies identifying a relationship between autonomic function (AF) and frailty in adults aged ≥65 years. Twenty-two studies of which two prospe...

Aims: Data on non-vitamin K antagonist oral anticoagulants (NOACs) use in patients with atrial fibrillation (AF) and frailty are scarce. Therefore, the impact of frailty on AF-related outcomes and benefit-risk profiles of NOACs in patients with frailty were investigated. Methods and results: AF patients initiating anticoagulation between 2013-20...

Background Atrial fibrillation (AF) is associated with cognitive decline, with anticoagulated subjects potentially having a reduced risk compared with non-anticoagulated subjects. However, whether non-vitamin K antagonist oral anticoagulants (NOACs) may reduce the risk of dementia compared with vitamin K antagonists (VKAs) is unclear yet. Therefore...

Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta-analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature sear...

Introduction: Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA). Methods: In this narrative review, we explore the dopaminer...

Background: Long-term care facilities (LTCFs) were high-risk settings for COVID-19 outbreaks. Objective: To assess the impacts of the COVID-19 pandemic on LTCFs, including rates of infection, hospitalisation, case fatality, and mortality, and to determine the association between control measures and SARS-CoV-2 infection rates in residents and staf...

Background and objective: (Patho)physiological changes in older people may influence the pharmacokinetics (PK), and consequently the target attainment, of ß-lactam antibiotics using standard dosing regimens. This systematic review compiles the current knowledge on the PK and target attainment of ß-lactam antibiotics in older people, with the aim t...

Purpose: The aim of this clinical review was to summarise the existing knowledge on fall risk associated with benzodiaz-epines (BZDs) and Z-drugs in older people with focus on appropriate prescribing, including deprescribing. Methods: We conducted a literature search in June 2021 in PubMed and Embase with citation and reference checking. Personal...

The Trial of Intensive Blood Pressure Control in Older Patients with Hypertension (STEP trial) is a very recent major trial which sought to determine whether lower systolic blood pressure (SBP) targets are beneficial for older adults with arterial hypertension. The Systolic Blood Pressure Intervention Trial (SPRINT) was another ‘big impact’ trial t...

Introduction: Certain trace elements are essential for life and affect immune system function, and their intake varies by region and population. Alterations in serum Se, Zn and Cu have been associated with COVID-19 mortality risk. We tested the hypothesis that a disease-specific decline occurs and correlates with mortality risk in different countri...

Recently, major trials have explored blood pressure targets that would provide greater benefit and fewer adverse events in older adult population on antihypertensive treatment. The last study was the STEP study conducted in China, which included 8511 older people aged 60–80 years. When systolic blood pressure below 130 mmHg was targeted in older in...

Purpose: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing appro...

Purpose: We aim to make desmopressin a safe treatment option for (older) patients at risk for hyponatremia, by introducing a new way of sodium monitoring. The goal is to reduce the risk of hyponatremia, enhance patient safety and ultimately introduce self-monitoring of sodium levels. The first step in the aforementioned is to validate capillary so...

Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults.MethodsA syste...

Objectives: To assess the association between self-reported sleep quality and nocturia in nursing home residents. Methods: The association between self-reported poor sleep quality and nocturia was examined in eighty nursing home residents from two nursing facilities using logistic regression analysis. Results: Poor sleep quality was reported b...

Sarcopenia - the accelerated loss of muscle mass, strength and function with ageing – represents an important health challenge with reduced quality of life and increased mortality.Gut microbiota has been suggested to contribute to this age-associated muscle wasting but the underlying mechanisms are still unclear. Here, we uncover the quorum sensing...

Background: Frailty and hypertension are interrelated, but it remains unclear whether this relationship is modified by anti-hypertensive drugs. Methods and results: A systematic review of PubMed and Web of Science databases was performed to review the influence of hypertension management on preventing the occurrence or progression of frailty in ol...

Introduction Older adults with atrial fibrillation (AF) have an increased risk of comorbidities and often take a combination of medicines. Moreover, it is known that anticoagulants tend to be underprescribed or underdosed in older patients with AF. Thus, it is important to evaluate the overall quality of prescribing because potentially inappropriat...

Introduction Individuals affected by atrial fibrillation (AF) often present with multiple comorbidities that challenge their clinical management and worsen the prognosis. Characterizing the network structure of comorbid chronic conditions in AF patients may provide insights to better tailor medical and care management. Purpose To examine and compa...

Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older partici...

Background: falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives: to create a set of evi...

Background and objective: Prescribing cascades occur when a drug is prescribed to manage side effects of another drug, typically when a side effect is misinterpreted as a new condition. A consensus list of clinically important prescribing cascades that adversely affect older persons' health (i.e., where risks of the prescribing cascade usually exc...

Current evidence on the relations between neighbourhood environments and older adults' health-related quality of life (HRQoL) relies mainly on cross-sectional studies. This longitudinal study aimed to examine the relations of neighbourhood socioeconomic status (SES) and objective and perceived physical environmental factors with 3-year changes in p...

In the context of population ageing, age prevalent conditions, such as, major neurocognitive disorder (dementia) are an important public health concern. This is especially so, because as yet, there is no cure for dementia. Therefore, knowledge and insights about relatively new concepts such as cognitive frailty (CF) – a heterogeneous clinical manif...

Falls and related injuries form a growing health-care problem in aging societies. Between 40 and 60% of older fallers in the last year report being injured. Around 15–20% of falls result in serious (non-fracture) injuries including fractures. Non-injurious falls have also been associated with adverse health effects, including accelerated functional...

Het is een algemeen bekend demografisch gegeven dat in de komende decennia het aantal oudere mensen mondiaal op een indrukwekkende wijze zal groeien. Onderzoek geeft aan dat-hoewel ouder worden geen ziekte is-deze ontwikkeling gepaard zal gaan met een stijgende zorgvraag waarbij de grijze druk (verhouding 65-plussers ten opzichte van de groep 20-65...

Background and Objective: Hypertension is the most prevalent chronic disease in older adults. Antihypertensive drug use increases with aging. In some studies, hypotension developing under antihypertensive medication use has been indicated as a potential risk factor for morbidity and mortality in older adults. Our objective was to assess the relatio...

Background: Due to increasing age and an increasing prevalence rate of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and dementia, independent living may become challenging. The use of socially assistive robots (SARs) is one solution that can enable older adults with cognitive impairment to remain independent. However, at presen...

Het aantal tachtigplussers neemt toe, wat resulteert in een toenemend aantal mensen met multimorbiditeit. Multimorbiditeit creëert polyfarmacie, wat bijgevolg, de meest consistente voorspeller is van ongepast voorschrijven en geneesmiddelgerelateerde problemen (GRP’s) bij ouderen. In dit hoofdstuk worden de belangrijkste kenmerken van polyfarmacie...

With population ageing, the number of older people is growing, which results in increasing number of people with multimorbidity and related polypharmacy. Polypharmacy in its turn leads to drug-related problems (DRPs) and potentially inappropriate prescribing (IP) in older people. In this commentary, susceptibility of older people to DRPs due to cha...

Few studies have assessed the association between perceived availability of homeand community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 20...

PurposeFall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitato...

Objectives This study analyzed cognitive differences between hearing-aid (HA) and non-HA users. We hypothesized that HA-use attenuates the auditory-cognitive cascade, thereby, the latter is more conspicuous in non-HA users. Since hearing impairment (HI) shows male predominance, we hypothesized gender differences within the auditory-cognitive relati...

Vitamin-D receptors are found in a variety of cells with the potential to regulate many cellular functions. Higher COVID-19 severity has been reported in individuals, which are known to have lower vitamin-D levels. The relation between vitamin-D and COVID-19 has been analysed with a number of studies but only few met high standards. Studies reveale...

Background: During the COVID-19 pandemic, mandatory containment measures led to lock-downs and severely diminished social interaction, with older adults being one vulnerable group. Socially assistive robots (SARs) could prove to be an effective intervention. Objectives: To explore the experiences of older adults with mild cognitive impairment (MCI)...

Importance With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. Objectives To perform a systematic review of...

Purpose To describe a guidance on the management of post-acute COVID 19 patients in geriatric rehabilitation. Methods The guidance is based on guidelines for post-acute COVID-19 geriatric rehabilitation developed in the Netherlands, updated with recent insights from literature, related guidance from other countries and disciplines, and combined wi...

Older people consume medicines in large quantities and many initiatives aim at reducing this drug load often called polypharmacy in this population. Given the fact that polypharmacy often leads to inappropriate prescribing and drug related problems, various instruments have been developed to identify potentially inappropriate medications (PIM), suc...

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which olde...

Rationale: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been recently introduced for type 2 diabetes treatment with significant cardiovascular, renal benefits. Yet, they have frequently been refrained in older adults. Metformin is regarded the firstline diabetes therapy in all ages; still it is associated with weight loss and frailty in...

The article was originally published electronically on the publisher’s internet portal on 07 August 2020 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 14 May 2021 to © The Author(s) 2021 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International...

We would like to thank Chen et al. for their comments on our recently published paper in Ageing Research Reviews (Veronese et al., 2021). In this reply we would like to answer to the points raised in their letter. Regarding the first question, we decided to run our search only in PubMed/Medline and ClinicalTrials.gov since the phase II-III randomiz...

Selenium (Se) and zinc (Zn) are essential trace elements needed for appropriate immune system responses, cell signalling and anti-viral defence. A cross-sectional observational study was conducted at two hospitals in Ghent, Belgium, to investigate whether Se and/or Zn deficiency upon hospital admission correlates to disease severity and mortality r...

During the COVID-19 pandemic older subjects have been disproportionately affected by the disease. Vaccination is a fundamental intervention to prevent the negative consequences of COVID-19, but it is not known if the needs and vulnerabilities of older people are adequately addressed by their inclusion in randomized clinical trials (RCTs) evaluating...

Zolpidem, zopiclon en zaleplon (dit laatste is niet meer beschikbaar in België), de zogenaamde Z-medicijnen, werden in de jaren tachtig van de vorige eeuw geïntroduceerd als een veiliger alternatief voor benzodiazepinen, die snel tot gewenning leiden, het eerste onder de merknaam Stilnoct® en het andere als Imovane®. Beide worden voorgeschreven als...

Background Use of drugs with anticholinergic properties (DAP) has a negative impact on older people.Objective Our aim was to examine the association between DAP at hospital admission and mortality in older patients.Patients and Methods We performed a nationwide population-based cohort study including patients aged ≥ 65 years admitted to Danish geri...

A geriatric patient with a perirectal abscess, pylephlebitis and multiple pyogenic liver abscesses: a case-report. In this case study, an 86-year-old patient is presented with fever, anorexia and drowsiness, a very high C-reactive protein (CRP) level and elevated liver enzymes. Given the frailty of the patient, a non-invasive diagnostic approach wa...

The COVID-19 pandemic brought development, evaluation and use of vaccines for older adults into the spotlight. Here, we reflect on the gaps that were highlighted and strategies to fill them, during the pandemic and beyond. This commentary draws on principles we compiled through the geriatric pharmacology subcommittee of the clinical division of the...

Objectives: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been recently introduced for type 2 diabetes treatment with significant cardiovascular, renal benefits. Yet, they have frequently been refrained in older adults. Metformin is regarded the first-line diabetes therapy for all ages; still it is associated with weight loss and frailt...

Background Older adults at a higher risk of adverse outcomes and mortality if they get infected with Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). These undesired outcomes are because ageing is associated with other conditions like multimorbidity, frailty and disability. This paper describes the impact of frailty on coronavirus dis...

When this paper was first published, there were errors in Figure 1 and Table 3. These errors have now been corrected online. In Figure 1, the text that read “No data available/lost to follow-up n = 56” should have read “No data available/lost to follow-up n = 40”. In Table 3, the text reading “Mortality (all-cause) within 30 days of randomization”...

Introduction Low Grip Work and high feelings of self-perceived fatigue could be an early characteristic of decline in reserve capacity, which comes to full expression as physical frailty in a later stage. When Grip Work and self-perceived fatigue can be identified as characteristics differentiating between robustness and pre-frailty it might allow...

Background falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a st...

Orale anticoagulantia staan centraal in de behandeling van voorkamerfibrillatie (VKF), waarbij niet-vitamine K-antagonist orale anticoagulantia (NOAC’s) de voorkeur hebben boven vitamine K-antagonisten (VKA’s). Vier grote gerandomiseerde en gecontroleerde studies (RCT’s) toonden aan dat NOAC’s een minstens evenwaardige effectiviteit en veiligheid h...

Polypharmacy is very common in older adults and increases the risk of inappropriate and unsafe prescribing for older adults. Older adults, particularly women (who make up the majority of this age group), are at the greatest risk for drug-related harm. Therefore, optimising drug prescribing for older people is very important. Identifying potentially...

Background The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP3S)-tool was developed in 2016 as a screening tool to detect drug-related problems (DRPs) and to help in performing medication reviews in older people (≥ 65 years).Objective This study aimed to revise and update the GheOP3S-tool.Methods Users’ comments were collect...

Objectives: We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged >65 years. Design: A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a...

Objective Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to rep...

PurposeTo describe the objectives, methods and expected impact of an international consortium (iKASCADE) whose purpose is to improve drug safety for older adults by addressing prescribing cascades through a sex and gender lens.Methods To create a comprehensive, internationally relevant inventory of prescribing cascades affecting older adults, the c...

The management of pharmacological therapy in older patients is challenging in clinical practice. Older subjects experience age-related changes that influence pharmacokinetics and pharmacodynamics of drugs, they also usually have multiple diseases, i.e., multimorbidity, and are often cared for, and hence, prescribed by a number of physicians over a...

Older adults, especially men and/or those with diabetes, hypertension and/or obesity, are prone to severe COVID‐19. In some countries, older adults, particularly those residing in nursing homes, have been prioritised to receive COVID‐19 vaccines due to high risk of death. In very rare instances,the COVID‐19 vaccines can induce anaphylaxis, and the...

Practical advice on the anaphylaxis policy for (COVID-19) vaccination in frail, older patients In view of the imminent start of the COVID-19 vaccination campaign, a practical advice based on the available literature on anaphylaxis in older people was drawn up for use in frail, older patients. The present practical advice provides guidance with rega...

Introduction Fatigue is a common complaint among older adults. Evidence grows that fatigue is linked to several negative health outcomes. A general overview of fatigue and its relationship with negative health outcomes still lacks in the existing literature. This brings complications for healthcare professionals and researchers to identify fatigue-...

Psychotropic drugs are widely prescribed in older people although their use is associated with important risks. In this position paper, we discuss the appropriateness of using these medications in older people in terms of different aspects such as indications, contraindications, dosing, adverse drug reactions, interactions and duration of therapy....

Background Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.MethodsA literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the eff...

Wanneer we spreken over hersenen bedoelen we gewoonlijk het geheel van de grote hersenen (cerebrum), de kleine hersenen (cerebellum) en de hersenstam. Die structuren liggen in de schedel en vormen samen met het ruggenmerg het centrale zenuwstelsel. De hersenen wegen gemiddeld ongeveer 1.300 gram, het gemiddelde gewicht bij mannen is iets groter dan...

IMPORTANCE With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. OBJECTIVES To perform a systematic review of c...

Background: Healthcare professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier and furthermore, there is no consensus on which medications are considered as FRIDs despite several systematic reviews. To support clinicians in the management of FRIDs and to facilitate...

The guidelines on hypertension recently published by the European Societies of Hypertension and Cardiology, have acknowledged cognitive function (and its decline) as a hypertension-mediated organ damage. In fact, brain damage can be the only hypertension-mediated organ damage in more than 30% of hypertensive patients, evolving undetected for severa...

Pharmaceutical agents are a valuable resource to assist in the care of older persons. Their use in post-acute and long-term care settings is particularly notabledfor example, the proportion of nursing home residents taking 9 or more medications increased from 18% in the mid-1990s to 40% less than 15 years later. Average drug counts are similarly hi...

Purpose: Practicing geriatric medicine is a challenging task since it involves working together with other medical doctors while coordinating a multidisciplinary team. Global Europe Initiative (GEI) group within the European Geriatric Medicine Society gathers geriatricians from different regions where geriatrics is underrepresented or still develop...

Purpose: Delirium in the intensive care unit (ICU) is often treated with haloperidol or atypical antipsychotics. An-tipsychotic treatment can lead to severe adverse effects and excess mortality. After initiation in the ICU, patients are at risk of having their antipsychotics continued unnecessarily at ICU and hospital discharge. This study aims to...

Purpose: The European Geriatric Medicine Society (EuGMS) is launching a second interim guidance whose aim is to prevent the entrance and spread of COVID-19 into long-term care facilities (LTCFs). Methods: The EuGMS gathered experts to propose a guide of measures to prevent COVID-19 outbreaks in LTCFs. It is based on the specific features of SARS-Co...