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Drugs & Aging

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https://www.readbyqxmd.com/read/28220381/pharmacological-management-of-people-living-with-end-stage-chronic-obstructive-pulmonary-disease
#1
Victoria Dalgliesh, Hilary Pinnock
Supportive care and pharmacological treatment can improve the quality of life of people with end-stage chronic obstructive pulmonary disease (COPD) who cope on a daily basis with substantial physical, psychological, social and spiritual morbidity. Smoking cessation is the only intervention that reduces the rate of progression of COPD, but evidence-based drug treatments and non-pharmacological strategies can relieve symptoms and reduce the impact of exacerbations. People with severe COPD live with increasingly troublesome breathlessness and other symptoms such as fatigue, pain, sputum production and weight loss...
February 21, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28220380/effectiveness-of-interventions-to-deprescribe-inappropriate-proton-pump-inhibitors-in-older-adults
#2
REVIEW
Tom D Wilsdon, Ivanka Hendrix, Tilenka R J Thynne, Arduino A Mangoni
BACKGROUND: The use of proton pump inhibitors (PPIs) in older adults is high, often inappropriate, and may cause harm. Deprescribing is defined as the reduction, withdrawal, or discontinuation of inappropriate medication. OBJECTIVE: We conducted a systematic review to determine the effectiveness of interventions to deprescribe inappropriate PPIs in older adults. METHODS: We searched MEDLINE, PubMed, Embase, the Cochrane Library, ProQuest Dissertations and Theses Global, and Google from inception to January 2017 for randomized and non-randomized studies describing the outcomes of interventions to deprescribe inappropriate PPIs in older adults (mean or median age of ≥65 years)...
February 21, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28214970/optimal-bowel-cleansing-for-colonoscopy-in-the-elderly-patient
#3
Samuel B Ho, Rita Hovsepians, Samir Gupta
Colonoscopy is an important diagnostic and screening tool for colorectal cancer detection and prevention, and adequate bowel preparation is critical for successful colonoscopy. Complications related to colonoscopy, either directly or indirectly related to the procedure, are increased in elderly patients, and the risks and benefits of colonoscopy procedures need to be carefully considered in these patients. Recent studies have shown that 4 L polyethylene glycol with a split preparation is safe and effective for elderly patients, and is the preferred preparation for patients with medical comorbidities...
February 18, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28197947/targeted-therapies-in-elderly-patients-with-metastatic-colorectal-cancer-a-review-of-the-evidence
#4
REVIEW
Gonzalo Tapia Rico, Amanda R Townsend, Vy Broadbridge, Timothy J Price
Metastatic colorectal cancer (mCRC) is the third leading cause of cancer deaths worldwide. As the population of the western world ages, the incidence of colorectal tumours among elderly patients is increasing and consequently so is the demand for treatments for elderly patients. Unfortunately, elderly patients (≥65 years) often go untreated and they are also under-represented in clinical trials. Yet there is some evidence suggesting that 'fit' elderly patients have similar outcomes and tolerance to chemotherapy treatment to their younger counterparts (although the definition of fitness in the elderly population is still a matter of debate)...
February 14, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28164255/late-onset-asthma-a-diagnostic-and-management-challenge
#5
Charlotte Suppli Ulrik
Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case history and spirometry), it is important to acknowledge that elderly individuals are likely to have diminished bronchodilator reversibility and some degree of fixed airflow obstruction. Elderly individuals, therefore, often require further objective tests, including bronchial challenge testing, to objectively confirm asthma...
February 6, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28138912/tolerability-of-cholinesterase-inhibitors-a-population-based-study-of-persistence-adherence-and-switching
#6
Anat Fisher, Greg Carney, Ken Bassett, Colin R Dormuth
BACKGROUND: Cholinesterase inhibitors (ChEIs) are prescribed to dementia patients despite their poor tolerance. Low tolerability potentially reduces persistence and adherence, while inducing switching between medications. Comparisons of these utilization measures contribute to knowledge of the relative tolerability of these medications. AIM: The aim was to compare persistence, adherence, and switching between donepezil, galantamine, oral rivastigmine, and rivastigmine patch...
January 30, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28138911/new-onset-diabetes-after-statin-exposure-in-elderly-women-the-australian-longitudinal-study-on-women-s-health
#7
Mark Jones, Susan Tett, Geeske M E E Peeters, Gita D Mishra, Annette Dobson
INTRODUCTION: Extensive clinical research has consistently shown statins lower the risk of cardiovascular events and mortality. Some studies also suggest statins increase the risk of new-onset diabetes. Research to date has rarely included elderly women, hence little is known about the risk of diabetes after statin exposure in this population. OBJECTIVES: Our objectives were to evaluate and estimate the risk of new-onset diabetes associated with statin exposure in a cohort of elderly Australian women...
January 30, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28124262/atypical-antipsychotics-and-the-risks-of-acute-kidney-injury-and-related-outcomes-among-older-adults-a-replication-analysis-and-an-evaluation-of-adapted-confounding-control-strategies
#8
Patrick B Ryan, Martijn J Schuemie, Darmendra Ramcharran, Paul E Stang
OBJECTIVE: A recently published analysis of population-based claims data from Ontario, Canada reported higher risks of acute kidney injury (AKI) and related outcomes among older adults who were new users of atypical antipsychotics (AAPs) compared with unexposed patients. In light of these findings, the objective of the current study was to further investigate the risks of AKI and related outcomes among older adults receiving AAPs. METHODS: A replication of the previously published analysis was performed using the US Truven MarketScan Medicare Supplemental database (MDCR) among patients aged 65 years and older...
January 25, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28120326/thrombolytic-treatment-for-ischaemic-stroke-could-the-crisis-of-confidence-have-been-avoided-by-better-analysis-of-trial-data
#9
REVIEW
David Barer, Eivind Berge
In many countries, thrombolysis with intravenous alteplase has become a central part of acute stroke care in recent years, requiring radical restructuring of services. However, a significant minority of emergency and stroke physicians have always had serious doubts about the safety and efficacy of thrombolytic treatment, and in 2015 these prompted a major review of the licensing status of alteplase by the UK regulatory authorities. Subsequent dramatic headlines and media stories have called into question the integrity of researchers and clinicians and undermined public faith in medical research...
January 24, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28074410/improving-medication-adherence-and-health-outcomes-in-older-adults-an-evidence-based-review-of-randomized-controlled-trials
#10
REVIEW
Zachary A Marcum, Joseph T Hanlon, Michael D Murray
BACKGROUND: Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. OBJECTIVE: The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adherence also improve the health outcomes of older adults residing in community-based settings. METHODS: Articles that assessed medication adherence interventions and related health outcomes in elderly individuals were identified through searches of MEDLINE (1970-June 2016), the Cochrane Database of Systematic Reviews (through to June 2016), and Google Scholar...
January 10, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28004259/can-a-multifaceted-intervention-including-motivational-interviewing-improve-medication-adherence-quality-of-life-and-mortality-rates-in-older-patients-undergoing-coronary-artery-bypass-surgery-a-multicenter-randomized-controlled-trial-with-18-month-follow-up
#11
Chung-Ying Lin, Mehdi Yaseri, Amir H Pakpour, Dan Malm, Anders Broström, Bengt Fridlund, Andrea Burri, Thomas L Webb
BACKGROUND: Patients undergoing coronary artery bypass graft (CABG) surgery are required to take a complex regimen of medications for extended periods, and they may have negative outcomes because they struggle to adhere to this regimen. Designing effective interventions to promote medication adherence in this patient group is therefore important. OBJECTIVE: The present study aimed to evaluate the long-term effects of a multifaceted intervention (psycho-education, motivational interviewing, and short message services) on medication adherence, quality of life (QoL), and mortality rates in older patients undergoing CABG surgery...
December 21, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/28000156/predicting-the-risk-of-adverse-drug-reactions-in-older-inpatients-external-validation-of-the-gerontonet-adr-risk-score-using-the-crime-cohort
#12
Mirko Petrovic, Balamurugan Tangiisuran, Chakravarthi Rajkumar, Tischa van der Cammen, Graziano Onder
BACKGROUND: Adverse drug reactions (ADRs) in older people are often preventable, indicating that screening and prevention programs aimed at reducing their rate are needed in this population. OBJECTIVE: The aim of this study was to externally validate the GerontoNet ADR risk score and to assess its validity in specific subpopulations of older inpatients. METHODS: Data from the prospective CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) cohort were used...
December 20, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27915457/combined-use-of-the-rationalization-of-home-medication-by-an-adjusted-stopp-in-older-patients-rasp-list-and-a-pharmacist-led-medication-review-in-very-old-inpatients-impact-on-quality-of-prescribing-and-clinical-outcome
#13
Lorenz Van der Linden, Liesbeth Decoutere, Karolien Walgraeve, Koen Milisen, Johan Flamaing, Isabel Spriet, Jos Tournoy
BACKGROUND: Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. OBJECTIVES: Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients...
December 3, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/28097633/meropenem-dosing-based-on-a-population-pharmacokinetic-pharmacodynamic-model-in-elderly-patients-with-infection-of-the-lower-respiratory-tract
#14
Qing-Tao Zhou, Bei He, Ning Shen, Ying Liang, Li-Na Sun
BACKGROUND: Meropenem is used for the treatment of severe lower respiratory tract infections (LRTIs) caused by multidrug-resistant Gram-negative bacilli. OBJECTIVE: We evaluated the clinical benefits of a strategy of meropenem dosing based on a population pharmacokinetics/pharmacodynamics (PK/PD) model in elderly patients with an LRTI. METHODS: In this prospective single-center open-label randomized controlled trial, 79 elderly patients with an LRTI caused by Gram-negative bacilli were randomized to a study group (SG) or a control group (CG)...
February 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28074409/management-of-depression-in-patients-with-dementia-is-pharmacological-treatment-justified
#15
REVIEW
Andrew H Ford, Osvaldo P Almeida
Depression in the context of dementia is common and contributes to poorer outcomes in individuals and those who care for them. Non-pharmacological treatments are the preferred initial approach to managing these symptoms but data in support of these are scarce. There are a number of pharmacological treatment options available to clinicians but efficacy is uncertain and concern about potential side effects in an aging and vulnerable population needs to be taken into consideration. This review aims to provide a concise overview of pharmacological treatments for depression in dementia...
February 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28025725/theory-based-interventions-to-improve-medication-adherence-in-older-adults-prescribed-polypharmacy-a-systematic-review
#16
REVIEW
Deborah E Patton, Carmel M Hughes, Cathal A Cadogan, Cristín A Ryan
BACKGROUND: Previous interventions have shown limited success in improving medication adherence in older adults, and this may be due to the lack of a theoretical underpinning. OBJECTIVE: This review sought to determine the effectiveness of theory-based interventions aimed at improving medication adherence in older adults prescribed polypharmacy and to explore the extent to which psychological theory informed their development. DATA SOURCES: Eight electronic databases were searched from inception to March 2015, and extensive hand-searching was conducted...
February 2017: Drugs & Aging
https://www.readbyqxmd.com/read/27928779/how-antibiotics-should-be-prescribed-to-hospitalized-elderly-patients-with-community-acquired-pneumonia
#17
Forest W Arnold
Elderly patients hospitalized with community-acquired pneumonia (CAP) should be administered antimicrobials in the emergency department prior to transfer to the ward or intensive care unit (ICU). For ward patients, a β-lactam with a macrolide or a respiratory fluoroquinolone alone should be given to cover typical and atypical pathogens. For ICU patients, a β-lactam with either a macrolide or a fluoroquinolone should be given. Other regimens are indicated if methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa is a concern...
January 2017: Drugs & Aging
https://www.readbyqxmd.com/read/27913982/pharmacological-management-of-allergic-rhinitis-in-the-elderly
#18
REVIEW
Andrzej Bozek
Recent studies suggest that allergic rhinitis is highly prevalent in the elderly population, but is underdiagnosed and undertreated. This review article briefly introduces allergic rhinitis in the elderly (epidemiology and pathophysiology) and identifies the main goals of treatment in these patients with respect to age-related physiological factors, comorbid conditions and polypharmacy. The primary focus of the article is a narrative review of the literature concerning the different types of treatment options in elderly patients aged 60+ years (pharmacological therapy and allergen-specific immunotherapy)...
January 2017: Drugs & Aging
https://www.readbyqxmd.com/read/27913981/the-challenges-of-anaesthesia-and-pain-relief-in-hip-fracture-care
#19
Rachel Cowan, Jun Hao Lim, Terence Ong, Ashok Kumar, Opinder Sahota
The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia...
January 2017: Drugs & Aging
https://www.readbyqxmd.com/read/27896799/a-comparison-of-sex-differences-in-psychotropic-medication-use-in-older-people-with-alzheimer-s-disease-in-the-us-and-finland
#20
Daniela C Moga, Heidi Taipale, Anna-Maija Tolppanen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen, Qishan Wu, Gregory A Jicha, Danijela Gnjidic
AIMS: Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer's disease (AD) living in the US and Finland. METHODS: We used data collected between 2005 and 2011 as part of the National Alzheimer's Coordinating Center (NACC) in the US, and Medication use and Alzheimer's disease (MEDALZ) cohorts in Finland...
January 2017: Drugs & Aging
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