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Antipsychotics in geriatric

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https://www.readbyqxmd.com/read/29674846/costs-of-medication-in-older-patients-before-and-after-comprehensive-geriatric-assessment
#1
Gulcin Done Unutmaz, Pinar Soysal, Busra Tuven, Ahmet Turan Isik
Background: Polypharmacy and inappropriate drug use cause numerous complications, such as cognitive impairment, frailty, falls, and functional dependence. The present study aimed to determine the effect of the comprehensive geriatric assessment (CGA) on polypharmacy, potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and to evaluate the economic reflections of medication changes. Methods: One thousand five hundred and seventy-nine older patients, who had undergone CGA, were retrospectively evaluated...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#2
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29589223/an-analysis-of-the-inclusion-of-medications-considered-potentially-inappropriate-in-older-adults-in-chemotherapy-templates-for-hematologic-malignancies-one-recommendation-for-all
#3
Amy Zhou, Holly M Holmes, Arti Hurria, Tanya M Wildes
BACKGROUND: There remains a paucity of data regarding the use of potentially inappropriate medications (PIMs) in the supportive management of older adults undergoing chemotherapy. Raising awareness among healthcare providers regarding the frequency of their use and potential toxicities may help to minimize the risks to patients. OBJECTIVE: The aim of this study was to evaluate the frequency of six specific classes of medications considered PIMs by the American Geriatrics Society Beers Criteria that are commonly included in the National Comprehensive Cancer Network (NCCN) chemotherapy order templates for hematologic malignancies...
March 27, 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29588595/the-impact-of-a-combined-intervention-program-an-educational-and-clinical-pharmacist-s-intervention-to-improve-prescribing-pattern-in-hospitalized-geriatric-patients-at-king-abdulaziz-medical-city-in-riyadh-saudi-arabia
#4
Muath Fahmi Najjar, Syed Azhar Syed Sulaiman, Majed Al Jeraisy, Hashim Balubaid
Background: There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage. Aim: The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients...
2018: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/29573769/-delirium-the-7th-vital-sign
#5
REVIEW
Rita Prayce, Filipa Quaresma, Isabel Galriça Neto
INTRODUCTION: Delirium is an acute, transient and fluctuating neuropsychiatric syndrome that is common in medical wards, particularly in the geriatric and palliative care population. MATERIAL AND METHODS: We present a brief literature review of the definition, pathophysiology, aetiology, diagnosis, prevention and treatment of delirium and its social and economic impact. RESULTS AND DISCUSSION: Delirium is under-recognized, especially by health professionals, and is associated with higher morbidity, mortality and economic burden...
January 31, 2018: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/29529421/clozapine-use-in-geriatric-patients-challenges
#6
REVIEW
Shiva Shanker Reddy Mukku, P T Sivakumar, Mathew Varghese
Clozapine is the first second generation antipsychotic with different receptor profile of action. Clozapine is the most efficacious drug for the treatment of psychotic disorder and is the drug of choice in treatment resistant schizophrenia. Clozapine is used in elderly patients infrequently owing to its adverse effects profile and tolerability. There is paucity of literature with respect to clozapine use in late life. In this narrative review, we discuss clozapine use in elderly and challenges associated with its use...
March 3, 2018: Asian Journal of Psychiatry
https://www.readbyqxmd.com/read/29358245/deprescribing-antipsychotics-for-behavioural-and-psychological-symptoms-of-dementia-and-insomnia-evidence-based-clinical-practice-guideline
#7
REVIEW
Lise M Bjerre, Barbara Farrell, Matthew Hogel, Lyla Graham, Geneviève Lemay, Lisa McCarthy, Lalitha Raman-Wilms, Carlos Rojas-Fernandez, Samir Sinha, Wade Thompson, Vivian Welch, Andrew Wiens
OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop antipsychotics; to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: The overall team comprised 9 clinicians (1 family physician, 1 family physician specializing in long-term care, 1 geriatric psychiatrist, 2 geriatricians, 4 pharmacists) and a methodologist; members disclosed conflicts of interest...
January 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29221501/lean-methodology-reduces-inappropriate-use-of-antipsychotics-for-agitation-at-a-psychiatric-hospital
#8
Joshana K Goga, Antonio Depaolo, Sunil Khushalani, J Ken Walters, Robert Roca, Marc Zisselman, Christopher Borleis
OBJECTIVE: To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. DESIGN: Historically Controlled Study. SETTING: Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit...
January 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/29171993/prevalence-of-delirium-in-a-population-of-elderly-outpatients-with-dementia-a-retrospective-study
#9
Desirée Addesi, Raffaele Maio, Nicoletta Smirne, Valentina Laganà, Natalia Altomari, Gianfranco Puccio, Rosanna Colao, Chiara Cupidi, Francesco Perticone, Amalia Cecilia Bruni
BACKGROUND: Delirium is a multifactorial geriatric syndrome and often occurs in patients with cognitive impairment. It also remains under-recognized, specifically in elderly outpatients, because signs of delirium might overlap with symptoms of dementia. OBJECTIVE: The aim of the present study is to retrospectively apply the chart-based delirium instrument on a cohort of elderly outpatients with dementia, to assess prevalence and features of delirium in this population...
2018: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/29109625/postoperative-delirium-in-elderly-citizens-and-current-practice
#10
REVIEW
Siddareddygari Velayudha Reddy, Jawaharlal Narayanasa Irkal, Ananthapuram Srinivasamurthy
Postoperative delirium (POD) represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29105246/role-of-potentially-inappropriate-medication-use-in-rehabilitation-outcomes-for-geriatric-patients-after-strokes
#11
Eiji Kose, Toshiyuki Hirai, Toshiichi Seki, Hiroyuki Hayashi
AIM: The effect of the use of potentially inappropriate medications (PIM) on mortality and functional outcome after strokes is unclear in Japan. The aim of the present study was to establish whether treatment with PIM affects functional improvements among geriatric patients convalescing after strokes. METHODS: This retrospective longitudinal study included consecutive geriatric patients admitted and discharged from convalescent rehabilitation wards for stroke between 2010 and 2016...
November 3, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28992823/impact-of-music-therapy-on-dementia-behaviors-a-literature-review
#12
REVIEW
Nora Fakhoury, Nathaniel Wilhelm, Kristen F Sobota, Kelly R Kroustos
Worldwide, dementia is the most important contributor to disability in elderly patients. Treating patients with dementia can be challenging for clinicians because of the numerous behavioral and psychological symptoms of dementia (BPSD). The Dementia Action Alliance and American Geriatrics Society Beers criteria promote nonpharmacological and behavioral treatments as first-line therapy to manage BPSD to avoid adverse events associated with antipsychotic medications. Some of the nonpharmacologic therapies proposed for BPSD include: music therapy (MT), light therapy, acupressure, aromatherapy, massage, and animal-assisted therapy...
October 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28873217/geriatrics-literature-2016-year-in-review
#13
Kaitlin Willham, Kenneth Covinsky, Eric Widera
We present 10 of the most effective articles from 2016 in geriatric medicine. They address wide-ranging topics including the use of antipsychotics for delirium in palliative care, fall prevention and mobility interventions, efficacy and potential risks of testosterone, cranberry capsules and their effect on bacteriuria and pyuria, beta-blockers after acute myocardial infarction in a nursing home population, the effect of a healthy lifestyle on disability, a goals-of-care intervention in individuals with advanced dementia, the benefits of regional anesthesia in hip repair, and mindfulness in chronic pain management...
October 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28856665/discharge-plans-for-geriatric-inpatients-with-delirium-a-plan-to-stop-antipsychotics
#14
Kim G Johnson, Adedayo Fashoyin, Ramiro Madden-Fuentes, Andrew J Muzyk, Jane P Gagliardi, Mamata Yanamadala
BACKGROUND: Studies show inpatient geriatric patients with reversible conditions like delirium may continue on antipsychotic medications without clear indications after hospital discharge. We conducted this study to determine how often geriatric patients were discharged on a newly started antipsychotic during admission with a plan for discontinuation of the antipsychotic documented in the discharge summary. DESIGN: We conducted retrospective chart review identifying geriatric inpatients in our health system started on a new antipsychotic during admission...
October 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28800801/behavioral-emergencies-special-considerations-in-the-geriatric-psychiatric-patient
#15
REVIEW
Awais Aftab, Asim A Shah
This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28793363/falls-a-fear-of-falling-and-related-factors-in-older-adults-with-complex-chronic-disease
#16
JuHee Lee, MoonKi Choi, Chang Oh Kim
AIMS AND OBJECTIVES: To identify factors influencing falls and the fear of falling among older adults with chronic diseases in Korea. BACKGROUND: The fear of falling and falls in older adults are significant health problems towards which healthcare providers should direct their attention. Further investigation is needed to improve nursing practice specifically decreasing risk of falls and the fear of falling in Korea. DESIGN: Descriptive, cross-sectional survey...
December 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28675999/subduing-the-green-eyed-monster-bridging-the-psychopharmacological-and-psychosocial-treatment-perspective-in-understanding-pathological-jealousy
#17
Farah Deena Abdul Samad, Hatta Sidi, Jaya Kumar, Srijit Das, Marhani Midin, Nurul Hazwani Hatta
Human being is not spared from a broad-ranged emotional state, including being jealous. Jealousy has both affective-cognitive and behavioural-evaluative dimension where the person perceives, or experiences a real threat on a valued relationship. As this complex emotion becomes irrational and not amenable to reason, it later transforms into a dangerously 'green-eyed monster'. This perilous situation which is viewed as pathological jealousy is a form of delusion, which is maintained by a fixed and false reasoning in an originally entrusted intimate relationship...
July 4, 2017: Current Drug Targets
https://www.readbyqxmd.com/read/28540050/effect-of-atypical-antipsychotics-on-body-weight-in-geriatric-psychiatric-inpatients
#18
Eugene Yh Yeung, Soojin Chun, Alan Douglass, Timothy E Lau
BACKGROUND: Studies suggest that antipsychotic-induced weight gain is not a great concern in the elderly population. This study investigated the weight change in elderly patients with various treatment duration and antipsychotics. Part 1 of the study was to determine whether atypical antipsychotics induced weight change in elderly patients. Part 2 was to determine whether certain atypical antipsychotics induced more weight change in elderly patients. METHODS: In Part 1, a retrospective chart review was done on 115 geriatric inpatients...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/28465867/differences-in-antipsychotic-related-adverse-events-in-adult-pediatric-and-geriatric-populations
#19
Hersh Sagreiya, Yi-Ren Chen, Narmadan A Kumarasamy, Karthik Ponnusamy, Doris Chen, Amar K Das
In recent years, antipsychotic medications have increasingly been used in pediatric and geriatric populations, despite the fact that many of these drugs were approved based on clinical trials in adult patients only. Preliminary studies have shown that the "off-label" use of these drugs in pediatric and geriatric populations may result in adverse events not found in adults. In this study, we utilized the large-scale U.S. Food and Drug Administration (FDA) Adverse Events Reporting System (AERS) database to look at differences in adverse events from antipsychotics among adult, pediatric, and geriatric populations...
February 26, 2017: Curēus
https://www.readbyqxmd.com/read/28436193/association-between-using-medications-with-anticholinergic-properties-and-short-term-cognitive-decline-among-older-men-a-retrospective-cohort-study-in-taiwan
#20
Yi-Hui Wu, Chih-Jen Wang, Cheng-Hao Hung, Liang-Yu Chen, Ming-Hsien Lin, Pei-Ning Wang, Liang-Kung Chen
AIM: The use of anticholinergic drugs had been strongly linked to adverse health outcomes among older adults, especially in cognitive impairment or dementia. The present study aimed to evaluate the cognitive decline related to the use of anticholinergic drugs among older men living in the veterans' homes in Taiwan. METHODS: This retrospective cohort study was a substudy of The Longitudinal Older Veterans study. A total of 274 residents living in four Taiwan veterans' homes and receiving two consecutive Mini-Mental State Examinations within the interval of 6 months from January 2012 to December 2014 were enrolled in the present study...
April 2017: Geriatrics & Gerontology International
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