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American Journal of Geriatric Pharmacotherapy

Connie Marras, Nathan Herrmann, Geoffrey M Anderson, Hadas D Fischer, Xuesong Wang, Paula A Rochon
BACKGROUND: Differences between atypical antipsychotics in their potential to cause parkinsonism and risk factors for antipsychotic-induced parkinsonism are not well established. There is a particular paucity of information on this in real-world use of these drugs, outside of clinical trial settings. OBJECTIVE: We compared the incidence of parkinsonism after new treatment with risperidone, olanzapine, or quetiapine in patients with dementia and examined the effects of dose and sex on the risk of parkinsonism...
December 2012: American Journal of Geriatric Pharmacotherapy
Edeltraut Kröger, Mieke Berkers, Pierre-Hugues Carmichael, Patrick Souverein, Rob van Marum, Toine Egberts
BACKGROUND: Two cholinesterase inhibitors (ChEIs), rivastigmine and galantamine, are used to treat Alzheimer disease in the Netherlands. Several adverse cardiac events have been reported for these medications. OBJECTIVE: We aimed to assess if the use of ChEIs increased the risk of cardiac events in the Netherlands. METHODS: A cohort crossover study of the PHARMO Record Linking System database included patients who initiated ChEIs at age 50 years or older, had at least 1 dispensing of a ChEI drug between 1998 and 2008, a 1-year history in PHARMO, and 1 subsequent dispensing of any medication...
December 2012: American Journal of Geriatric Pharmacotherapy
Gregory Reardon, Naushira Pandya, Edith A Nutescu, Joyce Lamori, Chandrasekhar V Damaraju, Jeff Schein, Brahim K Bookhart
BACKGROUND: Treatment of venous thromboembolism (VTE) in long-term care (LTC) settings has received little empirical study. OBJECTIVE: Among residents with VTE in nursing homes, this analysis evaluated frequency of anticoagulant use, the proportion of residents newly started on warfarin who persisted on therapy (≥3 months), and the association of key resident characteristics, including bleeding risk, with warfarin use and persistence. METHODS: Using the AnalytiCare LTC database (US), eligible residents had deep vein thrombosis or pulmonary embolism coded in the Minimum Data Set (MDS) 2...
December 2012: American Journal of Geriatric Pharmacotherapy
Parinaz K Ghaswalla, Spencer E Harpe, Daniel Tassone, Patricia W Slattum
BACKGROUND: Several classes of drugs, such as antibiotics, may interact with warfarin to cause an increase in warfarins anticoagulant activity and the clinical relevance of warfarin-antibiotic interactions in older adults is not clear. OBJECTIVE: The aim of this study was to determine the effect of oral antibiotics, such as amoxicillin, azithromycin, cephalexin, ciprofloxacin, levofloxacin, and moxifloxacin, on the international normalized ratio (INR) in patients ≥65 years on stable warfarin therapy...
December 2012: American Journal of Geriatric Pharmacotherapy
Richard H Stanford, Christopher M Blanchette, Melissa H Roberts, Hans Petersen, Anne L Fuhlbrigge
BACKGROUND: National asthma treatment guidelines recommend either the use of inhaled corticosteroids (ICS) or ICS in combination with a long-acting bronchodilator for the treatment of moderate to severe asthma. Even though asthma is common among older adults, few studies have assessed the differences in effectiveness between these two recommended therapies in patients over 65 years of age. OBJECTIVE: The aim of this study was to assess the association of the fluticasone-salmeterol combination (FSC) or ICS initiation on asthma-related events in Medicare-eligible asthma patients...
December 2012: American Journal of Geriatric Pharmacotherapy
Christine K O'Neil, Joseph T Hanlon, Zachary A Marcum
BACKGROUND: Osteoarthritis (OA) is the most common cause of disability in older adults, and although analgesic use can be helpful, it can also result in adverse drug events. OBJECTIVE: To review the recent literature to describe potential adverse drug events associated with analgesics commonly used by older adults with OA. METHODS: To identify articles for this review, a systematic search of the English-language literature from January 2001 to June 2012 was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of OA...
December 2012: American Journal of Geriatric Pharmacotherapy
Jennifer Tjia, Terry S Field, Kathleen M Mazor, Jennifer L Donovan, Abir O Kanaan, George Reed, Peter Doherty, Leslie R Harrold, Jerry H Gurwitz
BACKGROUND: Little attention has been focused on the safety of medications administered to treat non illnesses in nursing home residents with dementia. It is unclear whether this population is at increased risk of adverse drug events. OBJECTIVES: To test the hypotheses that in nursing home residents with dementia prescribed warfarin have less time in therapeutic range and a higher incidence of nonpreventable and preventable adverse warfarin events compared to nursing home residents without dementia after controlling for facility and patient characteristics...
October 2012: American Journal of Geriatric Pharmacotherapy
Clara Hjalmarsson, Lena Bokemark, Karin Manhem, Kirsten Mehlig, Björn Andersson
BACKGROUND: Although treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke. OBJECTIVE: The aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population. METHODS: We investigated the association between previous statin use and stroke severity (National Institutes of Health Stroke Scale [NIHSS]), as well as the effect of poststroke statin treatment on 12-month functional outcome (modified Rankin Scale [mRS] score) in 799 patients (mean age, 78 years), with acute ischemic stroke...
October 2012: American Journal of Geriatric Pharmacotherapy
Adrienne M Gilligan, Daniel C Malone, Terri L Warholak, Edward P Armstrong
BACKGROUND: Treatment disparities in Alzheimer's disease (AD) have received little attention. Determining whether disparities exist in this subpopulation is an important health policy issue. OBJECTIVE: The aim was to determine whether an association existed between race/ethnicity and exposure to AD pharmacotherapy across 4 state Medicaid populations. METHODS: Data from the Centers for Medicare and Medicaid Services (CMS) were used in this retrospective study...
October 2012: American Journal of Geriatric Pharmacotherapy
Shih-Yin Chen, Julie Vanderpoel, Samir Mody, Winnie W Nelson, Jeffrey Schein, Preethi Rao, Luke Boulanger
BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and disproportionately affects the elderly. OBJECTIVE: This study describes patient characteristics and caregiver assistance among Medicare beneficiaries with AF and examines factors associated with receiving anticoagulant treatment. METHODS: Patients with AF and age/gender-matched controls were identified from Medicare Current Beneficiary Survey data from 2001 to 2006...
October 2012: American Journal of Geriatric Pharmacotherapy
Sophia H Hu, Elizabeth Capezuti, Janice B Foust, Marie P Boltz, Hongsoo Kim
BACKGROUND: Studies of potential medication problems among older adults have focused on English-speaking populations in a single health care setting or a single potential medication problem. No previous studies investigated potential inappropriate medications (PIMs) and medication discrepancies (MDs) among older Chinese Americans during care transitions from hospital discharge to home care. OBJECTIVE: The aims of this study were to examine, in older Chinese Americans, the prevalence of both PIMs and MDs; the relationship between PIMs and MDs; and the patient and hospitalization characteristics associated with them during care transitions from hospital discharge to home care...
October 2012: American Journal of Geriatric Pharmacotherapy
Kalpana P Padala, Prasad R Padala, Dennis P McNeilly, Jenenne A Geske, Dennis H Sullivan, Jane F Potter
BACKGROUND: Statins are well-known for their cardiovascular benefits. However, the cognitive effects of statins are not well understood. We hypothesized that individuals with preexisting dementia would be more vulnerable to statin-related cognitive effects. OBJECTIVE: The aim of this study was to evaluate the impact on cognition of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) discontinuation and rechallenge in individuals with Alzheimer's dementia (AD) on statins at baseline...
October 2012: American Journal of Geriatric Pharmacotherapy
Kari A Mergenhagen, Sharon S Blum, Anne Kugler, Elayne E Livote, Jonathan R Nebeker, Michael C Ott, Daniel Signor, Soojin Sung, Jessica Yeh, Kenneth S Boockvar
BACKGROUND: Medication reconciliation (MR) has proven to be a problematic task for many hospitals to accomplish. It is important to know the clinical impact of physician- versus pharmacist-initiated MR in the resource-limited hospital environment. METHODS: This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. MR was implemented on 2 similar general medical units: one received physician-initiated MR and the other received pharmacist-initiated MR...
August 2012: American Journal of Geriatric Pharmacotherapy
Sejlo Koshoedo, Roy L Soiza, Rajib Purkayastha, Arduino A Mangoni
BACKGROUND: Medications with anticholinergic (antimuscarinic) effects negatively affect physical and cognitive function in community-dwelling older patients. However, it is unknown if anticholinergic drugs exert detrimental effects in older patients undergoing rehabilitation. OBJECTIVE: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. We speculated that higher anticholinergic drug exposure would be associated with reduced functional outcomes in this group...
August 2012: American Journal of Geriatric Pharmacotherapy
Nariman Mansur, Avraham Weiss, Yichayaou Beloosesky
BACKGROUND: Polypharmacy has been shown to influence outcomes in elderly patients. However, the impact of medication regimen complexity, quantified by the Medication Regimen Complexity Index (MRCI), on health outcomes after discharge of elderly patients has not been studied. OBJECTIVE: Our aim was to test the convergent, discriminant, and predictive validity of the MRCI in older hospitalized patients with varying functional and cognitive levels. METHODS: We retrospectively applied the MRCI to the medication regimen of 212 hospitalized patients and assessed its validity...
August 2012: American Journal of Geriatric Pharmacotherapy
Joshua M Thorpe, Carolyn T Thorpe, Korey A Kennelty, Walid F Gellad, Richard Schulz
BACKGROUND: The risk of potentially inappropriate medication (PIM), both prescription and over-the-counter, use in dementia patients is high. Informal caregivers often facilitate patients' use of medications, but the effect of caregiver factors on PIM use has not been a focus of previous research. OBJECTIVE: The aim of this study was to examine PIM use in dementia patients and caregivers and identify caregiver risk factors for PIM use in dementia patients. METHODS: We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study...
August 2012: American Journal of Geriatric Pharmacotherapy
Zachary A Marcum, Joseph P Vande Griend, Sunny A Linnebur
BACKGROUND: The US Food and Drug Administration (FDA) has new regulatory authorities intended to enhance drug safety monitoring in the postmarketing period. This has resulted in an increase in communication from the FDA in recent years about the safety profile of certain drugs. It is important to stay abreast of the current literature on drug risks to effectively communicate these risks to patients, other health care providers, and the general public. OBJECTIVE: To summarize 4 new FDA drug safety communications by describing the evidence supporting the risks and the clinical implications for older adults...
August 2012: American Journal of Geriatric Pharmacotherapy
Joseph P Vande Griend, Zachary A Marcum, Sunny A Linnebur
BACKGROUND: New drugs approved by the Food and Drug Administration (FDA) may offer tremendous clinical advances by providing health care providers with new treatment strategies. However, additional care must be taken for safe and effective use of these new agents by older adults. OBJECTIVE: Our objective was to identify FDA-approved medications in 2011 most likely to be prescribed to older adults, and to describe medication characteristics that may require special attention in this population...
August 2012: American Journal of Geriatric Pharmacotherapy
Noll L Campbell, Malaz A Boustani, Elaine N Skopelja, Sujuan Gao, Fred W Unverzagt, Michael D Murray
BACKGROUND: Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults. OBJECTIVE: Our aim was to conduct a systematic evidence-based review to identify barriers to medication adherence in cognitively impaired older adults and interventions aimed at improving medication adherence. METHODS: A search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed...
June 2012: American Journal of Geriatric Pharmacotherapy
Michael A Steinman, Rebecca L Sudore, Carolyn A Peterson, John B Harlow, Terri R Fried
BACKGROUND: Clinical practice guidelines have been criticized for insufficient attention to the unique needs of patients of advanced age and with multiple comorbid conditions. However, little empiric research is available to inform this topic. METHODS: We conducted telephone interviews with staff physicians and nurse practitioners in 4 VA health care systems. Respondents were asked to rate the usefulness of national heart failure guidelines for patients of different ages and levels of comorbid burden on a 5-point scale and to comment on the reasons for their ratings...
June 2012: American Journal of Geriatric Pharmacotherapy
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