Medication In Elderly Patients Research Articles

Do We Need to Assess the Effect of Treatment Withdrawal?

See related article, pages 2652–2657 . In this issue of Stroke , Colivicchi et al observe the impact of statin discontinuation after an ischemic stroke1: they suggest this phenomenon is not only frequent, but also associated with a significant increase of total mortality. Usually considered as secondary, the question of treatment withdrawal becomes more and more important because of: (1) the regular increase of the number of treatments with a convincing demonstration of preventive effects; (2) the general extension of life expectancy in high income countries, which explains both a dramatic increase in the numbers of elderly, and of the length of exposure to treatment far beyond that over which their effect has been estimated; (3) the high prevalence of treatment discontinuation, as illustrated by Colivicchi.1 If treatment effect were constant over time, we would expect similar effects across various ages, which is not the case for blood pressure–lowering drugs. A significant 10% to 15% decrease in total mortality has been associated with these treatments in hypertension around 60 years of age, with either diuretics2 or ACE-inhibitors3 as first-line drugs. Preliminary results (both from a subgroup meta-analysis4 and from a specific pilot trial5 …

Intracardiac hemodynamics and effects of nebulized bronchidilating therapy in elderly patients with asthma

The objective of the study was to evaluate right and left heart hemodynamics, right (RV) and left (LV) ventricular dyastolic function and effectiveness of nebulized bronchodilators. The study involved 86 elderly patients with bronchial asthma (BA). The control group included 22 elderly patients without lung or heart diseases. The results found remodeling RV and LV, RV and LV dyastolic dysfunction that worsened as asthma severity increased. These parameters correlated to a level of pulmonary hypertension which was mostly moderate (35.0 ± 7.9 mmHg). Nebulized bronchodilators improved the heart hemodynamics: pulmonary hypertension reduced, time and velocity parameters of RV and LV improved. The most effective medication in elderly patients with BA was Berodual.

Stopping Drugs That Cause Elders to Fall

In a recently published Dutch study, stopping specific medications in elderly patients with histories of falling reduced the incidence of falling by 50% ( Br J Clin Pharmacol 2007; 63:232). Now, the researchers report tilt-table testing outcomes after drug withdrawal in this cohort. The study included 135 older adults (mean age, 79) who …

Perception of potentially inappropriate medication in elderly patients by Slovak physicians

The aim of the present study was to determine the risk perception of potentially inappropriate drug treatment of elderly patients by Slovak physicians. In Slovakia, a list of such drugs is not available. The study sample consisted of 600 patients aged > or =65 years hospitalized at the Department of Internal Medicine in a Slovak general hospital between 1 December 2003 and 31 March 2005. The use of potentially inappropriate drugs at the time of hospital admission and discharge was compared. Potentially inappropriate drug use was defined by Beers 2003 criteria. In addition, 206 physicians were asked to mark the drugs that they considered potentially inappropriate for elderly patients out of a list provided in a questionnaire analysis. Out of 600 patients 20.2% and 20% were treated with at least one potentially inappropriate drug at the time of hospital admission and discharge, respectively. Hospitalization had no significant influence on the number of potentially inappropriate medicines used. The most frequently prescribed potentially inappropriate drugs were digoxin >0.125 mg/day and ticlopidine. Out of 206 responding physicians only 4.9% considered ticlopidine as potentially inappropriate for elderly patient. On the other hand, more than 20% of respondents were aware of the potential inappropriateness of amitriptyline, diazepam and chlordiazepoxide. Mentioned drugs were observed in less than 2% of study population (n = 600). The results of the questionnaire analysis in physicians as well as the prevalence of potentially inappropriate medication demonstrate that Slovak clinicians are aware of the risk of certain treatments in elderly patients.

Safety and tolerability of mood-stabilising anticonvulsants in the elderly

The authors review current research on the safety and tolerability of anticonvulsant medications used for individuals over the age of 60 years with affective disorders, agitation and other psychiatric disorders. Three anticonvulsants currently approved in the US for treatment of bipolar affective disorder are reviewed: valproate, lamotrigine and extended-release carbamazepine. The authors discuss the pharmacokinetics, pharmacodynamics, drug–drug interactions and the impact of ageing for each drug. There are few studies of anticonvulsant medications in elderly patients with bipolar disorder or other psychiatric conditions. Therefore, the authors summarise adverse events of greatest prevalence and/or greatest severity based on data derived predominately from studies of geriatric patients with epilepsy and/or other non-psychiatric indications. Guidelines are offered for the safe use of these medications in the elderly, based on research literature.

Therapy Insight: how changes in renal function with increasing age affect cardiovascular drug prescribing

Age is well recognized as a powerful prognostic factor in the setting of cardiovascular disease. With the aging of the US population, it is projected that more than 50 million people will be aged over 65 years by the year 2020. This growing elderly population has increased rates of morbidity and mortality owing to cardiovascular disease; however, proven therapies for prevention and treatment are often underused in older patients, largely because physicians perceive them as being frail and have limited understanding of age-related unique adverse and therapeutic effects. Advancing age is associated with a number of physiologic and pathophysiologic changes that impact the toxic effects, efficacy and dosing of many medications. Decreases in lean muscle mass affect the volume of distribution, and reductions in hepatic function affect the metabolism of many medications. Age-related reductions in renal function might have the most profound impact on the safety profile and dosing of medications in elderly patients. The strong association between renal and cardiovascular disease makes recognition of renal dysfunction and appropriate dose adjustment particularly important in elderly patients with cardiovascular disease. This article reviews current approaches to the estimation of renal function, and unique considerations related to prescribing medication for elderly patients with concomitant renal and cardiovascular disease.

Section 8: Disease Management in Heart Failure

Section 8: Disease Management in Heart Failure

유비쿼터스 투약 감시를 위한 스마트 투약 팩

As a pervasive healthcare application to help medication of elderly patients, the smart compliance monitors have been recently proposed. In this paper, we present a new smart drug/medicine pack (SDP) for ubiquitous medication monitoring, for which the packaging is either paper packet or blister pack. This ubiquitous compliance monitor is composed of several SDPs and a Bluetooth equipped PDA phone. The SDP is a wireless module that monitors the medication consumption unobtrusively by transmitting the sensed data of 'drug removal' events to the medical center and by reminding patients when they take a dose on their mobile phone. The communication between SDP modules and PDA is realized via Bluetooth. The PDA is basically embedded to indicate the medication record and to alert every prescribed medication time during treatment. Experimental results show that the proposed system works exactly when the SDPs are far within about 2 [m] from PDA.

Cerebral Blood Flow before and after Treatment with Amlodipine in Elderly Patients with Lacunar Infarction

ment of hypertension reduces the risk of ischaemic Patients were eligible for inclusion if they were stroke.[4-10] Moreover, a BP reduction in subacute admitted to Hakodate Municipal Hospital with and chronic stroke may also prevent lipohyalinosis symptomatic lacunar infarction from October 2000 and other vascular lesions associated with stroke. to September 2001. Infarctions were 90mm Hg or a systolic BP of >150mm Hg 3 weeks the lower limit of CBF autoregulation downwards in after the onset of lacunar infarction. Patients with spontaneously hypertensive rats.[16] Amlodipine lacunar infarction associated with embolism (exdoes not significantly affect relative indices of CBF cluding atrial fibrillation or ulcerations of the cerviin elderly hypertensive patients after BP lowering[17] cal internal carotid arteries) or lacunar infarction and it reduces the rate of carotid artery atherosclerorelated to the stenosis of a main trunk of a cerebral sis.[18] BP lowering with amlodipine has been shown artery, as determined by magnetic resonance angioto reduce stroke occurrence.[9] Such findings suggest graphy and/or digital subtraction angiography, were that amlodipine may be a suitable antihypertensive excluded. medication for elderly patients with acute stroke. Written informed consent was obtained from In our experience, reduction of systolic/diastolic either the patient or their closest relative. The study BP to normal (<140/85mm Hg) for lacunar infarcprotocol was approved by the Ethics Committee of tion is not harmful 2 weeks after the onset of stroke. Hakodate Municipal Hospital, Hokkaido, Japan. BP is reduced 2 weeks after stroke; the reduction Patients were treated medically with ozagrel for may be associated with normalisation of the sympa14 days after the onset of the infarction.[19] Rehabilithetic tone. At that time, further rehabilitation retation, including speech therapy, was started 2–3 quires stabilisation of BP. days after admission if the neurological deficit could

Problematic drugs in elderly patients presenting to a European emergency room

Background: Elderly patients are at an increased risk of developing complications from taking medication. Little is known about the inappropriate use of medication in elderly patients presenting to the emergency room, especially in very old patients. Methods: A random sample was drawn from patients aged 60 years or older who had been discharged from a medical emergency room. Charts were analyzed retrospectively. Potentially inappropriate medication was defined according to the 1997 Beers criteria. Results: At presentation, 24 (12.3%) of 195 patients aged 60 years and older were taking potentially inappropriate medications. Of 65 patients aged 80 years or older, 27.7% presented with potentially inappropriate medication, as compared to 4.6% in 130 patients aged 60–79 years. Patients older than 80 years were six times more likely than those aged 60–79 years to take problematic medication, despite similar average numbers of medications per patient. Emergency department physicians added potentially inappropriate drugs in three cases (1.5%). Conclusions: Among elderly patients presenting to the emergency department, one in 10 takes at least one problematic drug. Very old patients are at the greatest risk. Presentation of elderly patients to the emergency department offers an opportunity to review and optimize drug prescriptions.

Underuse of osteoporosis medications in elderly patients with fractures

Underuse of osteoporosis medications in elderly patients with fractures

Health survey data on potentially inappropriate geriatric drug use.

Studies have suggested that elderly patients do not always use medications appropriately. Investigations that have relied on prescription claim databases or clinical records focus on acquisition or prescription, and hypotheses must be made to assess actual consumption. Population survey data constitute an altemative way to study inappropriate use. To estimate the prevalence of potentially inappropriate use of medications in elderly patients in Québec based on self-reported use. Using a cross-sectional, general population, health survey in which self-reported medication use in the 2 days prior to the survey was recorded, we estimated the prevalence of inappropriate medication use in elderly patients (> or =65 y old) who responded. Two sets of published criteria were used to define inappropriate use: one to assess use of inappropriate drugs, and another to assess concomitant duplications and potential interactions. Of the 3400 patients surveyed, 6.5% had used > or =1 inappropriate drugs, 2.5% had > or =1 occurrences of potentially inappropriate duplication of medications, and 2.7% had > or =1 potential medication interactions. Concomitant use of at least 2 benzodiazepines was reported by 8.5% of respondents using these drugs. Use of > or =1 long-acting benzodiazepines was reported by 4.2% of the sample. Population health surveys are a useful tool for detecting potentially inappropriate medication use in the elderly. In particular, the high prevalence of inappropriate use of benzodiazepines signals a need for improved detection and intervention in this group.

Prescribing of psychotropics in the elderly: why is it so often inappropriate?

Psychotropic medications are an important treatment approach to mental health disorders; such disorders are common in the elderly population. Elderly patients are more likely to experience adverse effects from these agents than their younger counterparts due to age-related changes in pharmacodynamic and pharmacokinetic parameters. Because of these factors, inappropriate use of psychotropic medications in elderly patients has become a focus of concern. In general an agent is considered inappropriate if the risk associated with its use exceeds its benefit. Implicit and explicit criteria for inappropriate use of medications in the elderly have been created and include psychotropic agents. These criteria vary in their make-up but the explicit criteria tend to agree that amitriptyline, doxepin, and benzodiazepines that have long half-lives are not appropriate. Although explicit inappropriate medication criteria have been in existence since 1991, elderly patients continue to receive inappropriate psychotropic medications. A wide array of factors may be responsible for this practice. Provider-related causes include deficits in knowledge, confusion due to the lack of a consensus on the inappropriate psychotropic criteria, difficulties in addressing an inappropriate medication started by a previous provider, multiple prescribers and pharmacies involved in the care of a patient, negative perceptions regarding aging, and cost issues. Patients may contribute to the problem by demanding an inappropriate medication. Finally, the healthcare setting may inadvertently contribute to inappropriate prescribing by such policies as restrictive formularies or lack of reimbursement for pharmacists' clinical services. Successful approaches to optimising prescribing have been either educational or administrative. Educational approaches (e.g. one-on-one sessions, academic detailing) seek to influence decision making, while administrative approaches attempt to enforce policies to curtail the undesired practice. The US Omnibus Budget Reconciliation Act of 1987, which improved psychotropic medication use in long-term care, is an excellent example of administrative intervention. More research specifically focused on the causes of inappropriate psychotropic medication use and methods to avoid this practice is needed before targeted recommendations can be made.

Investigation of the Convenience of the Internet and the Reliability of Web-sites in Retrieval of Medical Information in Japan —About Medication for Elderly Patients with Myocardial Infarction—

Investigation of the Convenience of the Internet and the Reliability of Web-sites in Retrieval of Medical Information in Japan —About Medication for Elderly Patients with Myocardial Infarction—

Treatment-Refractory Depression in the Elderly: An Audit of Primary Care Referrals to Psychiatric Services in Swindon, U.K.

BACKGROUND: Our objective was to audit primary care referrals for depression to assess prereferral quality of antidepressant treatment. METHOD: We performed a retrospective audit of referrals from primary care to the Department of Old Age Psychiatry in Swindon, Wiltshire, U.K., for a new episode of depression, excluding life-threatening cases, between January 1, 1997, and December 31, 1998. To determine if treatment before referral met criteria for an adequate trial, for audit purposes we defined an adequate trial as 8 weeks at maximal dose as specified by the British National Formulary. RESULTS: A computer search identified 58 referrals: 33 cases were excluded-3 notes were unavailable for audit, 7 were wrongly coded, 8 were life-threatening, and 15 were non-primary care referrals. Of the 25 evaluable patients, 2 had had an adequate duration of treatment and 6 were taking maximal doses of antidepressants, but none was taking a dose for an adequate duration. CONCLUSION: Patients referred to secondary care for depression are often undertreated prior to referral, which may explain why the patients in this retrospective audit had failed to respond. Primary care physicians should be encouraged to use medication in elderly patients that requires little or no dose titration at high doses and for at least 8 weeks before considering the patient to be treatment refractory.

Non‐compliance and knowledge of prescribed medication in elderly patients with heart failure

To determine the extent of non-compliance to prescribed medication in elderly patients with heart failure and to determine to what extent patients recall information given regarding their medication. Non-compliance and knowledge of prescribed medication was studied in 22 elderly heart failure patients [mean age 79 +/- 6 (range 70-97); 14 (64%) male], using in-depth interviews performed 30 days after having been prescribed medication. All patients received standardised verbal and written information regarding their medication. Only 12 (55%) patients could correctly name what medication had been prescribed, 11 (50%) were unable to state the prescribed doses and 14 (64%) could not account for when the medication was to be taken, i.e. at what time of day and when in relation to meals the medication was to be taken. In the overall assessment six (27%) patients were found non-compliant and 16 (73%) patients were considered as possibly being compliant with their prescribed medication. Non-compliance was common in elderly heart failure patients, as were shortcomings in patients knowledge regarding prescribed medication, despite efforts to give adequate information. There exists a need for alternative strategies to improve compliance in these patients.

Successes and failures of current treatment of heart failure

Successes and failures of current treatment of heart failure

Withdrawal of long term diuretic medication in elderly patients: a double blind randomised trial

Objectives: About 20% of elderly people use long term diuretic medication, but there is doubt whether prolonged diuretic medication on such a large scale is necessary. We performed a study...

Adjunctive medication for elderly patients with depression

Adjunctive medication for elderly patients with depression

Start low and go slow: dosing of antipsychotic medications in elderly patients with dementia

Start low and go slow: dosing of antipsychotic medications in elderly patients with dementia