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Clinics in Geriatric Medicine

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https://www.readbyqxmd.com/read/28364997/inroads-into-polypharmacy-moving-forward-with-tools-deprescribing-and-philosophical-reflection
#1
EDITORIAL
Mary Ann E Zagaria
No abstract text is available yet for this article.
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364996/geriatric-polypharmacy-two-physicians-personal-perspectives
#2
REVIEW
Zhe Chen, Anthony Buonanno
Being a clinical provider in today's health care environment has become complex with more levels of care to negotiate. Who is caught in the middle of this complexity? Senior citizens. As we evolve into the new quality model, new problems and complexities occur. Numerous protocols and guidelines necessitate the initiation of drugs for given diagnoses and aggressive treatments. This article discusses geriatric polypharmacy from two practitioners' viewpoints: Zhe Chen, MD, discusses the point of view of a physician provider, and Anthony Buonanno, MD, discusses providers' roles in their own families...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364995/medication-risk-mitigation-coordinating-and-collaborating-with-health-care-systems-universities-and-researchers-to-facilitate-the-design-and-execution-of-practice-based-research
#3
REVIEW
Kevin T Bain, Calvin H Knowlton, Jacques Turgeon
The high prevalence of inappropriate polypharmacy in geriatric populations is unacceptable. Traditional medication risk mitigation (MRM) strategies have proven to be effective at improving polypharmacy, but these strategies have not consistently translated into positive health outcomes. Enhanced MRM strategies, such as using pharmacogenomics information, are needed, and these strategies need to be tested. A formidable challenge is successfully integrating pharmacogenomic information into clinical practice. As the medication experts on health care teams, pharmacists have a clear role to play in developing, integrating, and assessing enhanced MRM strategies to improve therapeutic outcomes for geriatric patients...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364994/can-managed-care-manage-polypharmacy
#4
REVIEW
Richard G Stefanacci, Taha Khan
Polypharmacy has come to mean the inappropriate use of multiple medications. Polypharmacy can occur as a result of a range of situations, including the excessive application of clinical guidelines, lack of coordination among multiple prescribers, treating adverse drug events, misaligned medications across transitions of care, patient self-treatment, and inappropriate overtreatment. Polypharmacy is a problem because the benefits of a specific medication at the dose and frequency that an individual patient is taking are often outweighed by the costs...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364993/medication-reconciliation-in-long-term-care-and-assisted-living-facilities-opportunity-for-pharmacists-to-minimize-risks-associated-with-transitions-of-care
#5
REVIEW
Linda G Gooen
The transitions of care process involves pharmacists and other members of the health care team who are in a position to collect, review, and analyze medications lists to help improve health care outcomes. Medication reconciliation is a complex process, especially when providing care to elderly population due to increased medication use, the movement of the patient from one health care setting to another, the number of acute and chronic illnesses, and the intervention of multiple health care providers in different facilities...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364992/geriatric-polypharmacy-pharmacist-as-key-facilitator-in-assessing-for-falls-risk
#6
REVIEW
Michelle A Fritsch, Penny S Shelton
This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364991/polypharmacy-and-delirium-in-critically-ill-older-adults-recognition-and-prevention
#7
REVIEW
Erik Garpestad, John W Devlin
Among older adults, polypharmacy is a sequelae of admission to the intensive care unit and is associated with increased medication-associated adverse events, drug interactions, and health care costs. Delirium is prevalent in critically ill geriatric patients and medications remain an underappreciated modifiable risk for delirium in this setting. This article reviews the literature on polypharmacy and delirium, with a focus on highlighting the relationships between polypharmacy and delirium in critically ill, older adults...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364990/polypharmacy-reduction-strategies-tips-on-incorporating-american-geriatrics-society-beers-and-screening-tool-of-older-people-s-prescriptions-criteria
#8
REVIEW
Hedva Barenholtz Levy
There is no single definition of polypharmacy. Use of 5 or more medications commonly is used. An alternative, quantitative definition, such as use of more medications than clinically indicated or use of unnecessary or harmful prescribing, has been proposed. Protocols or algorithms to improve polypharmacy and prescribing in older adults have been developed. The American Geriatrics Society (AGS) Beers Criteria and Screening Tool of Older People's Prescriptions (STOPP) explicit criteria reflect elements that are common across protocols and algorithms...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364989/the-role-of-patient-preferences-in-deprescribing
#9
REVIEW
Holly M Holmes, Adam Todd
Polypharmacy and the use of inappropriate medications has become an increasing problem globally. Deprescribing has gained attention as a means to rationalize medication use. Deprescribing interventions have been shown to be generally feasible and safe; in the few studies in which patient preferences are assessed, such interventions also seem to be acceptable to patients. Qualitative studies suggest that patients are interested in reducing medications, may need education about their medications to facilitate deprescribing, and highly value communication with their providers around deprescribing...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364988/centers-for-medicare-and-medicaid-services-support-for-medication-therapy-management-enhanced-medication-therapy-management-testing-strategies-for-improving-medication-use-among-beneficiaries-enrolled-in-medicare-part-d
#10
REVIEW
Nicole J Brandt, Catherine E Cooke
In 2006, Medicare beneficiaries began receiving prescription coverage benefits through Part D of the Medicare benefit. Medicare Part D plans must provide medication therapy (MTM) services. MTM services aim to improve medication use and are targeted toward eligible beneficiaries, determined by morbidity, prescription use, and anticipated cost of prescription use. Now, 10 years after the start of Medicare Part D, several changes have been made to the program's design. This article focuses on changes related to MTM and the impact that these changes have and will continue to have on Medicare beneficiaries and medication use...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886701/rheumatic-diseases-in-older-adults
#11
EDITORIAL
James D Katz, Brian Walitt
No abstract text is available yet for this article.
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886700/sj%C3%A3-gren-syndrome-and-other-causes-of-sicca-in-older-adults
#12
REVIEW
Alan N Baer, Brian Walitt
Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjögren syndrome is the prototypic disease associated with dryness of the eyes and mouth and predominantly affects women in their perimenopausal and postmenopausal years. In addition to topical treatment of the mucosal dryness, patients with Sjögren syndrome may require treatment with systemic immunomodulatory and immunosuppressive agents to manage a variety of extraglandular manifestations...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886699/rheumatologic-manifestations-of-malignancy
#13
REVIEW
Mandana Hashefi
A variety of conditions mimicking rheumatologic syndromes may be associated with an underlying malignancy. Therefore, distinguishing these syndromes from more common, nonparaneoplastic rheumatologic conditions can be perplexing. Some autoimmune conditions and the medications used for their management can be associated with increased future risk of malignancy. Some cancers can directly involve the musculoskeletal structures, whereas others present with systemic manifestations at sites away from the tumor and its metastases...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886698/regional-rheumatic-disorders-and-rehabilitation-in-older-adults
#14
REVIEW
Ana T Acevedo, Adrienne Jackson, Katharine E Alter
Musculoskeletal problems are the most frequently reported complaints among older adults living in the community. The impact of the aging process on skeletal muscles and joints can have a profound effect on the ability of individuals with and without disabilities to function. This article reviews the rehabilitation medicine approach to the evaluation of older adults with regional rheumatic disorders, and the rehabilitation medicine considerations for clinical interventions. Future research considerations are encouraged in order to gain a greater understanding of the subject matter and its impact on the provision of care and patients' quality of life...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886697/nonsurgical-management-of-osteoarthritis-knee-pain-in-the-older-adult
#15
REVIEW
Nora Taylor
Symptomatic knee osteoarthritis is a common complaint of many elderly patients in primary care offices. For those unable or unwilling to undergo knee replacement, the primary practitioners' understanding of the strengths and weaknesses of the available treatment modalities for pain relief is critical to successful in-office counseling and expectation management. Treatment requires a multimodal approach of nonpharmacologic and pharmacologic therapies to achieve a maximal clinical benefit. The focus of this review is on the nonsurgical options for treatment of knee osteoarthritis in patients aged 65 and older...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886696/a-review-of-osteoporosis-in-the-older-adult
#16
REVIEW
Paloma Alejandro, Florina Constantinescu
Osteoporosis in the elderly population is common. It results in more than 1.5 million fractures per year in the United States. The goal of managing osteoporosis is to prevent fractures. In men, osteoporosis is underrecognized and undertreated. More men than women die every year as a consequence of hip fractures. A review of diagnosis and treatment of osteoporosis is described in this article. Bisphosphonates are the first-line treatment for men and women. In the past several years, advances in bone biology have resulted in major therapeutic advances...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886695/pathogenesis-and-management-of-sarcopenia
#17
REVIEW
Robinder J S Dhillon, Sarfaraz Hasni
Sarcopenia represents a loss of muscle strength and mass in older individuals. Sarcopenia in the elderly has now become a major focus of research and public policy debate due to its impact on morbidity, mortality, and health care expenditure. Despite its clinical importance, sarcopenia remains under-recognized and poorly managed in routine clinical practice. This is, in part, due to a lack of available diagnostic testing and uniform diagnostic criteria. The management of sarcopenia is primarily focused on physical therapy for muscle strengthening and gait training...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886694/update-on-crystal-induced-arthritides
#18
REVIEW
Hossam El-Zawawy, Brian F Mandell
The prevalence of gout increases with age. Once serum concentration of urate exceeds the saturation/solubility point, it deposits in and around the joints. Clinical presentation in the elderly often has "atypical" features and is challenging to diagnose. Treatment depends on the stage of the disease and the patient's health status and comorbidities. Elderly patients often have several confounding issues; thus, treatment decisions can be complicated and therapeutic options limited. To prevent the recurrence of gout attacks, serum concentration of urate should be maintained well below the saturation threshold of 6...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886693/gaps-in-aging-research-as-it-applies-to-rheumatologic-clinical-care
#19
REVIEW
Una E Makris, Devyani Misra, Raymond Yung
The incidence and prevalence of rheumatologic conditions are increasing and the rheumatology workforce must be aware of aging-specific issues. This article reviews specific barriers to understanding the biology of aging and aging-related mechanisms that may underlie development of rheumatologic diseases in older adults. It summarizes gaps in the assessment, outcomes measurement, and treatment of these diseases in this unique population. It also highlights potential solutions to these barriers and suggests possible ways to bridge the gap, from a research and education standpoint, so that clinicians can be better prepared to effectively manage older adults with rheumatologic conditions...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27886692/cardiovascular-disease-risk-in-patients-with-rheumatic-diseases
#20
REVIEW
Rachel H Mackey, Lewis H Kuller, Larry W Moreland
Evidence suggests the greater than 1.5 increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) is related to an accelerated burden of subclinical atherosclerosis that develops before the diagnosis of RA. Dyslipidemia in RA is better quantified by lipoproteins and apolipoproteins than cholesterol levels. Current risk factors likely underestimate CVD risk partly by underestimating prior risk factor levels. To reduce CVD risk in RA, control disease activity and aggressively treat CVD risk factors...
February 2017: Clinics in Geriatric Medicine
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