Objectives To evaluate the efficacy and safety of megestrol for off-label use in older patients with weight loss. Design Retrospective, nonblinded cohort study. Setting Upstate University Hospital is a 420-bed facility and academic medical center with a level 1 trauma center. Upstate Community Hospital is a 314-bed acute care/hospital/ambulatory care center and long-term care hospital that also provides teaching services. Participants Patients 65 years of age and older without malignancy or acquired immunodeficiency syndrome who were initiated and continued megestrol therapy at the Upstate University hospitals for at least two weeks were included. Of the 1,290 patients initially screened, 16 patients on megestrol were evaluated. An age- and gender-matched control group of 16 patients was utilized for comparison of changes in weight and other variables. Interventions Patients in the megestrol group have received daily doses of megestrol between 160 mg to 800 mg for an average duration of 19 days. Patients in the control group had no history or current use of megestrol utilization. Main Outcome Measurements The primary outcome was an increase in weight. Secondary outcome measures included albumin and thromboembolic events. Changes in weight and albumin were also compared with the control group. Results At a mean duration of 19 days, there was no significant difference in weight gain (0.95 kg, OR = 1.33 [95% CI -1.615-3.527]). Albumin decreased by (0.4 g/dL OR = 0.916 [95% CI 0.12-0.78]) and none of the patients developed a thromboembolic event. Conclusion In older hospitalized patients, megestrol did not increase weight, and did not improve albumin. No thromboembolic events were observed, but this may be because of a limited duration of observation of therapy and the routine use of anticoagulation prophylaxis in the inpatient setting.
High levels of noise in hospital settings can make communication difficult, especially for older adults. Assistive Listening Devices (ALDs) are personal amplifiers that can improve hearing in background noise. This study investigated the impact of providing ALDs to hospitalized patients 60 years of age and older without using hearing screenings to determine eligibility. Results indicated that 96% of the patients reported that ALD was easy to use and 88% found it helpful. The ALD was used to communicate with family, hospital staff, and physicians. This suggests ALDs can be distributed to patients 60 years and older without any hearing screenings.
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The majority of clinical trials currently and historically do not include older adults or non-white participants. While more women are being recruited, their numbers are still limited. It is very hard to interpret trial results and apply them to older adults when their participation in clinical trials is limited. The focus of this article is the lack of clinical trial participation by persons of diverse races and ethnicities and the presentation of a model infrastructure grounded in community engagement that is proving to be effective in increasing the interest and participation of older African Americans in research.
Photographs taken at various community outreach activities led by the Community Research Liaison. See the related article by Sharon A. Brangman, pages 3080–3086.
