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