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Drug interactions in the elderly

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https://www.readbyqxmd.com/read/29408901/impact-of-person-centred-care-training-and-person-centred-activities-on-quality-of-life-agitation-and-antipsychotic-use-in-people-with-dementia-living-in-nursing-homes-a-cluster-randomised-controlled-trial
#1
Clive Ballard, Anne Corbett, Martin Orrell, Gareth Williams, Esme Moniz-Cook, Renee Romeo, Bob Woods, Lucy Garrod, Ingelin Testad, Barbara Woodward-Carlton, Jennifer Wenborn, Martin Knapp, Jane Fossey
BACKGROUND: Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost...
February 2018: PLoS Medicine
https://www.readbyqxmd.com/read/29408207/examining-the-epidemiology-and-microbiology-of-clostridium-difficile-carriage-in-elderly-patients-and-residents-of-a-health-care-facility-in-southern-ontario-canada
#2
Gabriella Mallia, Jane Van Toen, Joyce Rousseau, Latha Jacob, Patrick Boerlin, Amy Greer, Devon Metcalf, JScott Weese
BACKGROUND: While Clostridium difficile has been extensively studied in acute care facilities (ACFs), there is limited information about long-term care facilities (LTCFs), despite the high occurrence of putative risk factors (e.g. age, antimicrobial use, healthcare system contact). AIM: To evaluate C. difficile colonization in elderly patients and residents from ACF and its associated LTCF. METHODS: Stool swabs were collected from 884 LTCF and elderly (>65 years) hospital patients...
February 2, 2018: Journal of Hospital Infection
https://www.readbyqxmd.com/read/29392089/a-comprehensive-review-of-non-steroidal-anti-inflammatory-drug-use-in-the-elderly
#3
REVIEW
Supakanya Wongrakpanich, Amaraporn Wongrakpanich, Katie Melhado, Janani Rangaswami
NSAIDs, non-steroidal anti-inflammatory drugs, are one of the most commonly prescribed pain medications. It is a highly effective drug class for pain and inflammation; however, NSAIDs are known for multiple adverse effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID induced nephrotoxicity. As our society ages, it is crucial to have comprehensive knowledge of this class of medication in the elderly population. Therefore, we reviewed the pharmacodynamics and pharmacokinetics, current guidelines for NSAIDs use, adverse effect profile, and drug interaction of NSAIDs and commonly used medications in the elderly...
February 2018: Aging and Disease
https://www.readbyqxmd.com/read/29360070/-reduction-of-inappropriate-prescriptions-and-adverse-effects-to-medications-in-hospitalized-elderly-patients
#4
Ana Fajreldines, Eduardo Schnitzler, Jorge T Insua, Mariana Valerio, Laura Davide, Marcelo Pellizzari
Together, potentially inappropriate prescribing of medications (PIP) and appropriate prescribing omission (APO) constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE). This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment)...
2018: Medicina
https://www.readbyqxmd.com/read/29352622/anaesthesia-for-caesarean-section-in-a-patient-with-parkinson-s-disease
#5
V D Ward
Parkinson's disease is prevalent worldwide but mainly affects the elderly and is rarely seen in women of child-bearing age. The clinical signs and symptoms, the physiological changes of pregnancy, and drug interactions, pose unique challenges for the anaesthetic management of patients with Parkinson's disease who present for delivery. A 36-year-old primigravid woman at 36 weeks' gestation, with Parkinson's disease, presented for pre-anaesthesia assessment prior to elective caesarean section. Her Parkinson's disease had been diagnosed four years previously and was treated with Sinemet (levodopa/carbidopa) and pramipexole...
November 21, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29340963/interactions-between-drugs-and-geriatric-syndromes-in-nursing-home-and-home-care-results-from-shelter-and-ibenc-projects
#6
Graziano Onder, Silvia Giovannini, Federica Sganga, Ester Manes-Gravina, Eva Topinkova, Harriet Finne-Soveri, Vjenka Garms-Homolová, Anja Declercq, Henriëtte G van der Roest, Pálmi V Jónsson, Hein van Hout, Roberto Bernabei
AIM: Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. METHODS: We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project...
January 16, 2018: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/29340718/drug-treatment-of-heart-failure-in-the-elderly
#7
REVIEW
D Berliner, J Bauersachs
The prevalence of heart failure increases with age. Changes in the age distribution and growing life expectancy will lead to a further rise. However, data concerning drug treatment of heart failure especially in the elderly are scarce. Subgroup analyses of the heart failure trials suggest that drug therapy in older patients should follow the recommendations in the current guidelines. In doing so, several common comorbidities in these patients (e. g., impaired renal function) have to be considered and may have an influence on the therapy (e...
January 16, 2018: Herz
https://www.readbyqxmd.com/read/29339702/efficacy-and-safety-of-oral-anticoagulation-in-elderly-patients-with-atrial-fibrillation
#8
Ilaria Cavallari, Giuseppe Patti
Elderly patients with atrial fibrillation are at a higher risk of both ischemic and bleeding events compared with younger patients; therefore, balancing risks and benefits of antithrombotic strategies in this population is crucial. Recent studies have shown that because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation is the highest in elderly patients in whom it outweighs the risk of bleeding. Direct oral anticoagulants (DOACs) have been developed as a treatment for the prevention of cardioembolic stroke to overcome some limitations of warfarin, such as the need for frequent monitoring, labile INR values requiring frequent dose adjustment, dietary and drugs interactions, and increased risk of intracranial bleeding...
January 2018: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/29339167/comparison-of-anticoagulant-therapy-for-atrial-fibrillation-novel-oral-anticoagulants-versus-vitamin-k-antagonists
#9
REVIEW
Sean T Chen, Manesh R Patel
In patients with non-valvular atrial fibrillation (NVAF), oral anticoagulation is important for prevention of stroke and systemic embolism (SE). While Vitamin K antagonists (VKAs) have historically been the standard of care, these medications are limited by numerous food and drug interactions with onerous requirements for frequent monitoring and dose adjustments. Over the past decade, several novel oral anticoagulants (NOACs) have been developed to directly inhibit factor IIa/thrombin (dabigatran) or activated factor X (apixaban, rivaroxaban, edoxaban)...
January 12, 2018: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29338456/an-update-on-the-safety-of-nutraceuticals-and-effects-on-lipid-parameters
#10
Arrigo F G Cicero, Alessandro Colletti
Cardiovascular diseases (CVDs) are the leading cause of mortality and disability in developed countries, whereas a large portion of patients in primary prevention have uncontrolled level of CVD risk factors. Dietary supplementation with bioactive natural compounds with demonstrated lipid-lowering effects is currently supported by the international guidelines for CVD prevention and some international expert panels. Areas covered: This review provides insights on issues concerning the tolerability and safety of the most commonly used nutraceuticals with demonstrated lipid-lowering effect in humans...
January 16, 2018: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/29337859/effects-of-pharmacists-interventions-on-inappropriate-drug-use-and-drug-related-readmissions-in-people-with-dementia-a-secondary-analysis-of-a-randomized-controlled-trial
#11
Maria Gustafsson, Maria Sjölander, Bettina Pfister, Jörn Schneede, Hugo Lövheim
Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications (PIMs) pose a significant risk of drug-drug interactions and adverse drug events among elderly people with dementia. This study aimed at analysing the effects of clinical pharmacists' interventions on use of PIMs, risk of emergency department visits, and time to institutionalization. Furthermore, a descriptive analysis was conducted of circumstances associated with drug-related readmissions...
January 16, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29319495/investigation-of-the-age-dependency-of-vancomycin-clearance-by-population-pharmacokinetic-modeling
#12
Muhammad Usman, Manfred Fobker, Georg Hempel
PURPOSE: The aim of this study was to evaluate the influence of age and other possible covariates on vancomycin clearance in order to define a possible cut off value of age for dose optimization in elderly patients from data obtained during therapeutic drug monitoring. MATERIALS AND METHODS: Population pharmacokinetic analysis of 256 samples obtained from 144 patients was performed by using NONMEM<sup>®</sup>. A one-compartment model was applied as the base model with first-order conditional estimation method with interaction (FOCE-I)...
February 2018: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29310996/appropriateness-of-statin-prescription-in-the-elderly
#13
M Ruscica, C Macchi, C Pavanello, A Corsini, A Sahebkar, C R Sirtori
Statins, the most widely used drugs in the Western world, have become a pivotal component in the primary and secondary prevention of vascular diseases. Although benefits have been well documented in younger-than-75-year-old individuals, the value of statins in people aged >75years and over is controversial. The CTT meta-analysis calculated an absolute risk reduction of 0.6%/year per 38.7mg/dl reduction in LDL-C levels in patients aged >75years, that would translate into a number needed to treat of 167...
January 5, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29304725/patient-perceived-barriers-and-facilitators-to-the-implementation-of-a-medication-review-in-primary-care-a-qualitative-thematic-analysis
#14
Mirella Carolin Uhl, Christiane Muth, Ferdinand Michael Gerlach, Goentje-Gesine Schoch, Beate Sigrid Müller
BACKGROUND: Although polypharmacy can cause adverse health outcomes, patients often know little about their medication. A regularly conducted medication review (MR) can help provide an overview of a patient's medication, and benefit patients by enhancing their knowledge of their drugs. As little is known about patient attitudes towards MRs in primary care, the objective of this study was to gain insight into patient-perceived barriers and facilitators to the implementation of an MR. METHODS: We conducted a qualitative study with a convenience sample of 31 patients (age ≥ 60 years, ≥3 chronic diseases, taking ≥5 drugs/d); in Hesse, Germany, in February 2016...
January 5, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29278992/comorbidity-polytherapy-and-drug-interactions-in-a-neurological-context-an-example-of-a-multidisciplinary-approach-to-promote-the-rational-use-of-drugs
#15
Giulia Busa, Alessandro Burlina, Vera Damuzzo, Marco Chiumente, Angelo C Palozzo
PURPOSE: A high number of adverse drug reactions (ADRs), mainly caused by drug-drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated-(1) the prevalence of drug-drug and drug-disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug-drug and drug-disease interactions. METHODS: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge...
February 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29260237/-anticoagulation-in-geriatric-patients-with-atrial-fibrillation-with-what-and-for-whom-no-more
#16
REVIEW
P Bahrmann, M Christ
Based on established risk scores, such as the CHA 2 DS 2 -VASc score, the indications for oral anticoagulation are given for patients over 65 years old with atrial fibrillation and even more so for patients over 75 years old. Before beginning anticoagulation a geriatric assessment for evaluation of the cognitive ability, the activities of daily living and the risk of falling should be made because of the known complications of anticoagulation. Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with non-vitamin K antagonist oral anticoagulants (NOAC) to prevent ischemic stroke...
December 19, 2017: Herz
https://www.readbyqxmd.com/read/29258890/serotonergic-and-cholinergic-modulation-of-functional-brain-connectivity-a-comparison-between-young-and-older-adults
#17
Bernadet L Klaassens, Joop M A van Gerven, Erica S Klaassen, Jeroen van der Grond, Serge A R B Rombouts
Aging is accompanied by changes in neurotransmission. To advance our understanding of how aging modifies specific neural circuitries, we examined serotonergic and cholinergic stimulation with resting state functional magnetic resonance imaging (RS-fMRI) in young and older adults. The instant response to the selective serotonin reuptake inhibitor citalopram (30 mg) and the acetylcholinesterase inhibitor galantamine (8 mg) was measured in 12 young and 17 older volunteers during a randomized, double blind, placebo-controlled, crossover study...
December 16, 2017: NeuroImage
https://www.readbyqxmd.com/read/29210840/conoscere-e-curare-il-cuore-1986-2016-how-the-heart-has-changed
#18
Alessandro Boccanelli
: The demographic transition, with longer life expectancy, is mainly due to prevention and care of atherosclerotic vascular and heart disease. The cardiovascular patient is now much older and often presents with coexisting geriatric syndromes that affect healthcare goals, outcomes, and the process of care. Numerous mechanisms at cellular level are responsible for cardiovascular aging such as replicative senescence, apoptosis, proteins misfolding, and inflammation. Aging-related modifications are increase in left-ventricular mass, increased left atrial size, myocardial collagen deposition, and calcium deposition in valvular structures and the coronary arteries...
November 27, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/29209239/genetic-biomarkers-on-age-related-cognitive-decline
#19
REVIEW
Chieh-Hsin Lin, Eugene Lin, Hsien-Yuan Lane
With ever-increasing elder populations, age-related cognitive decline, which is characterized as a gradual decline in cognitive capacity in the aging process, has turned out to be a mammoth public health concern. Since genetic information has become increasingly important to explore the biological mechanisms of cognitive decline, the search for genetic biomarkers of cognitive aging has received much attention. There is growing evidence that single-nucleotide polymorphisms (SNPs) within the ADAMTS9, BDNF, CASS4, COMT, CR1, DNMT3A, DTNBP1, REST, SRR, TOMM40, circadian clock, and Alzheimer's diseases-associated genes may contribute to susceptibility to cognitive aging...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29199172/when-proton-pump-inhibitors-are-compared-are-there-specific-cases-in-which-a-certain-proton-pump-inhibitors-should-be-particularly-preferred
#20
Altay Çelebi, Hasan Yılmaz
Currently, proton pump inhibitors (PPIs) are widely used either over the counter or on prescription drugs. PPI's are frequently used with other drugs when elderly and chronic desease burden population is taken to consideration. Drug interactions with PPIs are a prominent clinical problem in this direction. In this study, we reviewed potential risks of concomittant use of PPIs and other drugs and apropriate PPI choise.
December 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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