Esther M. M. van de Glind

Cardiopulmonary resuscitation (CPR) was developed in the 1950s as a treatment for cardiopulmonary arrest. Outcome of CPR remains poor, particularly in older people, as demonstrated by two recent meta-analyses. The first addressed out-of-hospital resuscitation in patients aged 70 years and over, and found pooled overall rates of survival to discharge of 4.1%. For in-hospital resuscitation, the overall pooled rate of survival to discharge was 18.7% for patients aged 70–79 years, 15.4% for patients aged 80–89 years and 11.6% for those aged 90 or over. It is not clear if age alone is a limiting factor, or rather a marker of comorbidity. Overall, information about the quality of life after surviving CPR is lacking. Older patients should be adequately informed about their chances of survival in good condition in order to make a decision about the desirability of CPR.

Objectives: To determine how many individual patient data ( IPD ) reviews that included older people were available in MEDLINE and whether the effectiveness of treatments differed between older and younger individuals. Design: Overview of IPD reviews. Setting: A MEDLINE search was conducted for IPD reviews of randomized controlled trials published before July 2012. Participants: IPD reviews that presented a regression model that included age as a factor or a subgroup analysis of individuals aged 70 and older or in which all participants were aged 70 and older. Measurements: Whether the IPD reviews reported similar conclusions for the younger and older populations was evaluated. Results: Twenty‐six IPD reviews with a subgroup of older individuals and eight reviews with only older individuals were included (median N = 3,351). The most important reason for choosing an IPD review was the ability to perform a subgroup analysis in the older population. Fourteen IPD reviews suggested that older people should receive different treatments from younger people because of differences in effectiveness, six of which indicated that the investigated treatment(s) should be avoided in older adults. Conclusion: IPD review is a valuable approach for generating evidence in older adults. Treatment effects frequently differed between older and younger individuals. Still, IPD results should be applied to older adults cautiously, because they are often excluded from primary trials. The collaborative sharing of raw data should be promoted to improve evidence‐based decisions for this group.

Background: Until now, multiple reviews on the pharmacological treatment of dementia have been published. Methods: We performed a scoping review to summarize research findings and to identify gaps in the existing literature. We searched the literature and assessed the risk of bias of the included reviews. A team of clinical experts assessed the fields in which more research is necessary. Fifty-five reviews with a low risk of bias were included, most of them concerning the treatment of cognitive decline (n = 16) and behavioral symptoms (n = 10) in Alzheimer's disease (AD). For cognitive impairment, cholinesterase inhibitors (n = 13) and memantine (n = 7) were described most frequently. Little information was found about the treatment of depression in dementia. Conclusions: For many current treatments, there is sufficient evidence. New research should focus on the symptomatic treatment of the earliest and most salient complaints in AD as well as on disease-modifying interventions acting at the level of the amyloid cascade.