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Drugs & Aging

Manuela L Ferreira, Andrew McLachlan
Sciatica is a debilitating condition affecting approximately 25 % of the population. Typically, the patient will complain of lower limb pain that is more severe than pain in the lower back, usually accompanied by numbness and motor weakness. Most international guidelines recommend pharmacological management for the pain relief of sciatica, including paracetamol, non-steroidal anti-inflammatory drugs, opioid analgesics, anticonvulsants, and corticosteroids, among others. However, the evidence for most of these pharmacological options is scarce, and the majority of clinical trials exclude older patients...
October 13, 2016: Drugs & Aging
Minhee Kim, Luca Borradori, Dédée F Murrell
Elderly patients are more susceptible to the development of autoimmune blistering disorders such as bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, and paraneoplastic pemphigus. This article focuses on the clinical aspects of the aforementioned autoimmune blistering diseases and highlights the important factors involved in treating elderly patients. It is essential for clinicians to offer individualized treatment plans for these patients to optimize outcomes, as elderly patients often have multiple co-morbidities, polypharmacy, and suboptimal socioeconomic status that can adversely influence adequate compliance...
October 13, 2016: Drugs & Aging
Eva Sönnerstam, Maria Sjölander, Maria Gustafsson
BACKGROUND: Older people are more sensitive to drugs and adverse drug reactions than younger people because of age-related physiological changes such as impaired renal function. As people with dementia are particularly vulnerable to the effects of drugs, it is especially important to evaluate the dosages of renally cleared medications in this group. OBJECTIVE: The aim of this study was to estimate the prevalence of impaired renal function and inappropriate prescriptions on the basis of renal function among older patients with dementia or cognitive impairment...
October 12, 2016: Drugs & Aging
Jelena Osmanovic-Barilar, Melita Salkovic-Petrisi
Hormone therapy (HT) is prescribed during or after menopausal transition to replace the decline in estrogen and progesterone levels. While some studies indicate that estrogen and progesterone depletion in postmenopausal women might carry a significant risk for developing sporadic Alzheimer's disease (sAD), which may be reduced by HT, recent clinical trials oppose this beneficial effect. This review points to possible reasons for these mixed data by considering the issues of both preclinical and clinical trials, in particular, the representativeness of animal models, timing of HT initiation, type of HT (different types of estrogen compounds, estrogen monotherapy vs...
October 6, 2016: Drugs & Aging
Hoang Kim Tu Trinh, Ga-Young Ban, Ji-Ho Lee, Hae-Sim Park
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD...
October 6, 2016: Drugs & Aging
Anette Bygum, Inmaculada Martinez-Saguer, Murat Bas, Jeffrey Rosch, Jonathan Edelman, Mikhail Rojavin, Debora Williams-Herman
BACKGROUND: Treatment of hereditary angioedema (HAE) in 'older adults' (those aged ≥65 years) has not been well studied. The international Berinert Patient Registry collected data on the use of intravenous plasma-derived, pasteurized, nanofiltered C1-inhibitor concentrate (pnfC1-INH; Berinert(®)/CSL Behring) in patients of any age, including many older adults. METHODS: This observational registry, conducted from 2010 to 2014 at 30 US and seven European sites, gathered prospective (post-enrollment) and retrospective (pre-enrollment) usage and adverse event (AE) data on subjects treated with pnfC1-INH...
October 4, 2016: Drugs & Aging
Gilbert Lefèvre, Francesca Callegari, Sandro Gsteiger, Yuan Xiong
INTRODUCTION: The glomerular filtration rate (GFR), a measure of renal function, decreases by approximately 10 mL/min every 10 years after the age of 40 years, which could lead to the accumulation of drugs and/or renal toxicity. Pharmacokinetic studies of drugs excreted both renally and non-renally are desirable in patients with impaired renal function, defined by parameters including estimated GFR (eGFR) and creatinine clearance (CLCR). OBJECTIVE: We describe here a population pharmacokinetic analysis of the possible effects of renal impairment on steady-state plasma concentrations of rivastigmine and its metabolite NAP226-90 after rivastigmine patch (5 cm(2) [4...
September 28, 2016: Drugs & Aging
Nandita Kachru, Sneha Sura, Satabdi Chatterjee, Rajender R Aparasu
BACKGROUND: Antimuscarinic medications are the first-line pharmacological treatment for overactive bladder (OAB); however, little is known about the utilization pattern of antimuscarinic agents in elderly patients with OAB. OBJECTIVE: This study examined the prevalence and predictors of antimuscarinic medication prescribing in elderly patients with OAB, using national ambulatory survey data. METHODS: This cross-sectional study utilized the 2009-2010 National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Medical Care Survey...
September 28, 2016: Drugs & Aging
Dominik Spira, Jeremy Walston, Nikolaus Buchmann, Jivko Nikolov, Ilja Demuth, Elisabeth Steinhagen-Thiessen, Rahel Eckardt, Kristina Norman
BACKGROUND: Pharmacological options for the treatment of sarcopenia currently do not exist. However, off-label treatment options of some established drugs have been suggested. OBJECTIVES: The aim of this study was to assess differences in various muscle and physical performance parameters in relation to the intake of angiotensin-converting enzyme (ACE) inhibitors in a cohort of community-dwelling older people. METHODS: Eight hundred and thirty-eight participants from the Berlin Aging Study-II (BASE-II) were included...
September 24, 2016: Drugs & Aging
Sunil Swami, Ronald A Cohen, John A Kairalla, Todd M Manini
BACKGROUND: Age-associated decline in central cholinergic activity makes older adults susceptible to the harmful effects of anticholinergic (AC) medications; however, there is an inadequate understanding of the association and possible effects of AC drugs on cognition. This cross-sectional study examines the associations of AC medications on cognition among older adults with questionable cognitive impairment (QCI). METHODS: For this cross-sectional study, we used a multicenter database of community-dwelling older adults (N = 7351) aged 60+ years with QCI, from September 2005 to March 2014, as the baseline data...
September 17, 2016: Drugs & Aging
Colin M Curtain, Mackenzie Williams, Justin M Cousins, Gregory M Peterson, Tania Winzenberg
BACKGROUND: It is currently recommended in Australia that nursing home residents are supplemented daily with 1000 IU vitamin D as they are at an increased risk of fractures. Historically, supplementation has been low, and current supplementation prevalence is not known. OBJECTIVE: The aim of this study was to determine the prevalence of vitamin D supplementation amongst nursing home residents in Tasmania, Australia. METHODS: Resident data, including demographics, medical conditions and medications (including vitamin D and calcium supplement use), exercise and sun exposure, were obtained from residents' files and staff in consenting nursing homes...
September 1, 2016: Drugs & Aging
Shamsuddin Akhtar, Joseph Heng, Feng Dai, Robert B Schonberger, Mathew M Burg
BACKGROUND/OBJECTIVES: Despite guidelines suggesting a 25-50 % reduction in induction doses of intravenous anesthetic agents in the elderly (≥65 years), we hypothesized that practitioners were not sufficiently correcting drug administration for age, contributing to an increased incidence of hypotension in older patients undergoing general anesthesia. STUDY DESIGN: We conducted a retrospective, observational study in a tertiary-care academic hospital. The study included 768 female patients undergoing gynecologic surgeries who received propofol-based induction of general anesthesia...
August 31, 2016: Drugs & Aging
Jing Liu, Bin Yang, Jun Ke, Wenjia Li, Wen-Chen Suen
Alzheimer's disease (AD), one of the most devastating diseases for the older population, has become a major healthcare burden in the increasingly aging society worldwide. Currently, there are still only symptomatic treatments available on the market, just to slow down disease progression. In the past decades, extensive research focusing on the development of immunotherapy using monoclonal antibodies (mAbs) as potential "disease-modifying drugs" has shown promise in inhibiting or clearing the formation of toxic amyloid-β (Aβ) species, the suspected causative agents of AD...
October 2016: Drugs & Aging
E W de Roos, J C C M In 't Veen, G-J Braunstahl, L Lahousse, G G O Brusselle
Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients...
September 2016: Drugs & Aging
Luca Pasina, Sarah Astuto, Laura Cortesi, Mauro Tettamanti, Carlotta Franchi, Alessandra Marengoni, Pier Mannuccio Mannucci, Alessandro Nobili
BACKGROUND: Explicit criteria for potentially inappropriate prescriptions in the elderly are recommended to avoid prescriptions of duplicate drug classes and to optimize monotherapy within a single drug class before a new agent is considered. Duplicate drug class prescription (or therapeutic duplicates) puts the patient at increased risk of adverse drug reactions with no additional therapeutic benefits. To our knowledge, the prevalence of elderly inpatients receiving therapeutic duplicates has never been studied...
September 2016: Drugs & Aging
Luis Sargento, Andre Vicente Simões, Susana Longo, Nuno Lousada, Roberto Palma Dos Reis
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) is a disease of older people, but the target doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are unknown. OBJECTIVE: To evaluate the association of ACEI/ARB dose level with long-term survival in stable older patients (aged >70 years) and octogenarian outpatients with HFrEF. POPULATION AND METHODS: A total of 138 outpatients aged >70 years (35...
September 2016: Drugs & Aging
Olivier Beauchet, John Barden, Teresa Liu-Ambrose, Victoria L Chester, Cedric Annweiler, Tony Szturm, Sébastien Grenier, Guillaume Léonard, Louis Bherer, Gilles Allali
BACKGROUND: Few studies have examined the effect of anti-dementia drugs (i.e., acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists) on gait performance. Past studies have focused on the stride time (i.e., gait cycle duration) but not on the mental imagery of gait. OBJECTIVES: To compare mental imagery of gait and spatiotemporal gait parameters in patients with dementia [i.e., Alzheimer's disease (AD) and non-AD] before and after the use of anti-dementia drugs (i...
September 2016: Drugs & Aging
Beatriz Abadia, Pilar Calvo, Antonio Ferreras, Fran Bartol, Guayente Verdes, Luis Pablo
The risk of severe eye problems has been found to increase significantly with age, particularly between the fifth and sixth decades of life. Cataracts, dry eye, neovascular age-related macular degeneration, diabetic retinopathy and retinal vein occlusion (RVO) are very common and very different age-related ocular diseases that reduce the patient's quality of life. The rationale for using corticosteroids to treat anterior and posterior ocular segment diseases is driven by inflammation. Dexamethasone, one of the most powerful corticosteroids available, is widely used for topical or intravitreal administration...
September 2016: Drugs & Aging
Alexandr Poprach, Radek Lakomy, Zbynek Bortlicek, Bohuslav Melichar, Tomas Pavlik, Ondrej Slaby, Rostislav Vyzula, Marek Svoboda, Igor Kiss, Hana Studentova, Milada Zemanova, Ondrej Fiala, Katerina Kubackova, Ladislav Dusek, Jana Hornova, Tomas Buchler
BACKGROUND: Although a significant proportion of patients with metastatic renal cell carcinoma (mRCC) are elderly, the data on the outcomes of targeted therapies in this population are limited. The aim of the present retrospective registry-based study was to analyse efficacy and toxicity of sunitinib as the first-line targeted therapy of elderly mRCC patients. PATIENTS AND METHODS: The national RENal information system registry of mRCC patients treated with targeted agents in the Czech Republic was used as the data source...
September 2016: Drugs & Aging
Alessandra Marengoni, Alessandro Monaco, Elisio Costa, Antonio Cherubini, Alexandra Prados-Torres, Christiane Muth, Renè J F Melis, Luca Pasina, Tischa J M van der Cammen, Katie Palmer, Sergio Pecorelli, Graziano Onder
Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients. Non-adherence to medications affects the quality and length of life and has been associated with negative health outcomes and increasing healthcare costs. The problem of non-adherence is particularly troublesome in older patients who are affected by multiple chronic diseases and for this reason receive multiple treatments. To date, no single intervention strategy has been shown to be effective in improving adherence across all patients, conditions, and settings...
September 2016: Drugs & Aging
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