EBM GERIATRICDr. Sufi Desrini M.Sc

INTRODUCTION

2010 2020 2030 2040 2050

Developed countries Total populationPopulation ≥65 y%of total population

1.365.899204.14014,9

1.397.353248.21517.8

1.411.479298.21523.2

1.412.224327.12223.2

1.402.753343.39624.5

Developing CountriesTotal populationPopulation ≥65 y% of total population

5.539.491323.7165.8

6.267.938467.2557.5

6.903.864671.5579.7

7.408.412919.18512.4

7.785.1051.122.96314.4

INTRODUCTION

INTRODUCTION

Evidence-based Medicine (EBM)“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.”

(David Sackett)

Evidence-Based Medicines• EBM is a coined in 1992 by a

group of clinical epidemiologist based at McMaster University in Hamilton, Ontario

• How to use the literature in the care of an individual patient

• Emphasized 3 basic consept

What is the Practice of EBM?

• Where there is evidence of benefit and value, do it

• Where there is evidence of no benefit, harm, or poor value, don’t do it.

• When there is insufficient evidence to know for sure, be conservative.

Why is EBM Needed?

Knowledge Decay –Unanswered Questions

Knowledge Decay –Information Explosion

The Inevitable Consequence: Knowledge Decay

Evidence-based Practice (EBP)

What does “evidence-based” mean?

What is “good evidence”?

Hierarchy of evidence

Hierarchy of evidence

Hierarchy of evidence1. RCT2. Systematic reviews of

randomized trials3. Systematic review of

observational studie4. Physiologic studies5. Unsystematic observation

Hierarchy of evidence• http://www.ncbi.nlm.nih.gov/pub

med/clinical/

• Clinical study categories

Clinically meaningful results

Clinically meaningful results

APPLICABILITY

Limitations of Guidelines in elderly people

APPLICABILITY

Limitations of Guidelines in elderly people

Limitations of Guidelines in elderly people

Limitations of Guidelines in elderly people

Limitations of Guidelines in elderly people

Limitations of Guidelines in elderly people• In RCT sample size, duration

and co-prescribed drug therapies are often tailored to the target disease and geriatrics problems (disability, cognitive impairment, multimorbidity, life expectancy and sosioeconomic difficulties are seldom considered

Limitations of Guidelines in elderly people• That limitations make it difficult

to extrapolate the results of clinical trial and the resulting guideline recommendation to older people

How can we tackle the new challenges of an aging population

Question• “In an elderly woman with

hypochromic, microcytic anaemia, can a low ferritin diagnose iron deficiency anaemia?” You order a ferritin and head for the library (10 days later it comes back at 40 μg/l)

Search using the MeSH• “ferritin” and “sensitivity and

specificity”• find an article on diagnosing iron

deficiency anaemia in the elderly published in a journal that your library does take

• (Am J Med 1990;88:205-9)

Read the article and decide

1.Are the results of this diagnostic article valid?

2. Are the valid results of this diagnostic study important?

3. Can you apply this valid, important evidence about a diagnostic test in caring for your patient?

Thank You