Treatment Decisions for Metastatic Clear Cell Renal Cell Carcinoma in Older Patients: The Role of TKIs and Immune Checkpoint Inhibitors
AbstractGiven the underrepresentation of older patients in registration trials for metastatic renal cell carcinoma (mRCC), data to support the use of any particular systemic therapy over others, based on age, is limited. This is further complicated by clinical trials not commonly reporting adverse events by age. Thus, recommendations on treatment of older patients with mRCC are generally extrapolated from data on younger patients enrolled in these trials, which may not be ideal as many older patients are frail, have age-related organ dysfunction, or have multiple medical co-morbidities. In the last decade, the treatment la...
Source: Drugs and Aging - February 20, 2019 Category: Geriatrics Source Type: research

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research
AbstractFalls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge disseminatio...
Source: Drugs and Aging - February 11, 2019 Category: Geriatrics Source Type: research

Angiotensin-Converting Enzyme Inhibitor Use and Incident Frailty: A Longitudinal Cohort Study
ConclusionACEI use may be associated with a reduced risk of frailty in individuals with/at risk of knee osteoarthritis, suggesting a potential role for ACI in the prevention of frailty. (Source: Drugs and Aging)
Source: Drugs and Aging - February 9, 2019 Category: Geriatrics Source Type: research

Age-Associated Hematological Toxicity in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with Docetaxel in Clinical Practice
ConclusionThe risk of hematological toxicity was significantly higher in the oldest age quartile than in younger patients with mCRPC treated with docetaxel in daily clinical practice. (Source: Drugs and Aging)
Source: Drugs and Aging - February 8, 2019 Category: Geriatrics Source Type: research

Clinical Outcomes Associated with Drug –Drug Interactions of Oral Chemotherapeutic Agents: A Comprehensive Evidence-Based Literature Review
ConclusionOur findings suggest that more real-world studies evaluating the association between oral chemotherapy DDIs and clinical outcomes are needed. The adverse clinical outcomes due to DDIs may be a reason for treatment failures and therapy discontinuation. (Source: Drugs and Aging)
Source: Drugs and Aging - February 4, 2019 Category: Geriatrics Source Type: research

Potentially Inappropriate Prescribing and Related Hospital Admissions in Geriatric Patients: A Comparative Analysis between the STOPP and START Criteria Versions 1 and 2
AbstractBackgroundOlder persons are at significant risk of drug-related admissions (DRAs). We previously demonstrated that 27% of hospitalizations in geriatric patients were associated with potentially inappropriate medicines (PIMs) and/or potential prescribing omissions (PPOs) identified by the Screening Tool of Older People ’s Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 1 (v1). The updated STOPP/START criteria version 2 (v2) comprised a 31% increase in prescribing criteria.ObjectiveAs a secondary analysis of our study conducted in 2008, we aimed to compare the prevalence ...
Source: Drugs and Aging - January 29, 2019 Category: Geriatrics Source Type: research

Pharmacological Management of Dementia with Lewy Bodies
AbstractDementia with Lewy bodies (DLB) is a complex disease that involves a variety of cognitive, behavioral and neurological symptoms, including progressive memory loss, visual hallucinations, parkinsonism, cognitive fluctuations and rapid eye movement sleep behavior disorder (RBD). These symptoms may appear in varying combinations and levels of severity in each patient who is seen in the clinic, making diagnosis and treatment a challenge. DLB is the third most common of all the neurodegenerative diseases behind both Alzheimer ’s disease and Parkinson’s disease (PD). The median age of onset for DLB (76.3 ...
Source: Drugs and Aging - January 25, 2019 Category: Geriatrics Source Type: research

Practical Regional Anesthesia Guide for Elderly Patients
AbstractUltrasound-guided regional anesthesia is an important part of the practice of anesthesia for the elderly population, the growth of which will continue to outpace that of the younger population due to improvements in lifespan worldwide. The elderly patient is uniquely vulnerable to the effects of systemic anesthetic drugs, and our understanding of the potential toxicities that general anesthetics can have on the elderly brain and body continues to evolve. Aging impacts both the pharmacokinetics and pharmacodynamics of sedative medications and local anesthetics. Alongside the physiologic aging process often comes a m...
Source: Drugs and Aging - January 25, 2019 Category: Geriatrics Source Type: research

Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment
AbstractFoot and ankle osteoarthritis (OA) is a common and disabling problem that adversely affects physical function and significantly reduces quality of life. Although the knee was considered to be the lower-limb site most often affected by OA, recent population data showed foot OA is as prevalent as knee OA, and rates increase with advancing years. The most common foot OA sites include the first metatarsophalangeal joint and the midfoot, with the ankle affected less often. Despite the high prevalence and disabling nature of foot and ankle OA, the condition has been neglected by clinical researchers, and there are very f...
Source: Drugs and Aging - January 25, 2019 Category: Geriatrics Source Type: research

Treatment of Patients with Advanced Gastroesophageal Adenocarcinoma: Does Age Matter?
AbstractGastroesophageal cancer is the fourth most frequent malignant disease and, despite significant advances in chemotherapy, the prognosis of unresectable or recurrent gastroesophageal cancer is poor. The majority of patients, nearly two-thirds, are over the age of 65  years at diagnosis. Elderly patients are a heterogeneous population and aging occurs at different rates in different individuals. The chronological age of a patient does not necessarily reflect the physiological age. However, elderly patients are more likely to have a number of concomitant disease s and impaired organ function, which should be consi...
Source: Drugs and Aging - January 25, 2019 Category: Geriatrics Source Type: research

Interventions to Improve Antimicrobial Stewardship for Older People in Care Homes: A Systematic Review
ConclusionThe interventions had limited effect on improving antimicrobial prescribing but did not appear to cause harm to care home residents. The low quality of evidence and heterogeneity in outcome measurement suggest the need for future well-designed studies and the development of a core outcome set to best evaluate the effectiveness of antimicrobial stewardship in care homes. (Source: Drugs and Aging)
Source: Drugs and Aging - January 24, 2019 Category: Geriatrics Source Type: research

Effect of a Pharmacist-Driven Medication Management Intervention Among Older Adults in an Inpatient Setting
The objective of this study was to compare the number of potentially inappropriate medications (PIMs) on admission to the number of PIMs on discharge following pharmacist intervention.Patients and MethodsThis was a prospective, single-center pilot study performed at a tertiary medical center. Eighty-two adults aged 65  years or older on five or more medications who were admitted to the general medicine floor between December 2016 and May 2017 were included in the analysis. Pharmacists completed a review of prior admission medications and identified PIMs. Recommendations for PIMs were communicated to the medical team a...
Source: Drugs and Aging - January 23, 2019 Category: Geriatrics Source Type: research

Prescriber Implementation of STOPP/START Recommendations for Hospitalised Older Adults: A Comparison of a Pharmacist Approach and a Physician Approach
AbstractBackgroundTwo randomised controlled trials (RCTs) conducted simultaneously in the same Irish university teaching hospital have shown that provision of Screening Tool of Older Persons ’ Prescriptions (STOPP)/Screening Tool to Alert doctors to Right Treatment (START) recommendations to attending prescribers by a physician or a pharmacist can reduce in-hospital adverse drug reactions (ADRs) in older adults (≥ 65 years). The aims of this study were to compare the prescriber i mplementation rates of STOPP/START recommendations between the physician approach and the pharmacist approach in these two R...
Source: Drugs and Aging - January 19, 2019 Category: Geriatrics Source Type: research

Drugs Contributing to Anticholinergic Burden and Risk of Fall or Fall-Related Injury among Older Adults with Mild Cognitive Impairment, Dementia and Multiple Chronic Conditions: A Retrospective Cohort Study
ConclusionsThe same daily ACB score was associated with a different degree of risk, depending on the ACB ratings of the individual drugs comprising the score. Combinations of level 2 and level 3 drugs had the greatest risk of fall or fall-related injury relative to other individuals with the same daily ACB score. Low-potency anticholinergic drugs taken together modestly  increased the hazard of a fall or fall-related injury. (Source: Drugs and Aging)
Source: Drugs and Aging - January 17, 2019 Category: Geriatrics Source Type: research

Pigmentation Disorders in the Elderly
This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly. (Source: Drugs and Aging)
Source: Drugs and Aging - January 14, 2019 Category: Geriatrics Source Type: research

Factors to Consider in the Selection of Dopamine Agonists for Older Persons with Parkinson ’s Disease
AbstractDopamine agonists (DAs) are frequently used in the management of Parkinson ’s disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiological compensatory mechanisms. Pharmacotherapy for moto r symptoms in older persons is more likely to involve exclusive use of levodopa combined with a peripheral decarboxylase inhibitor throughout the course of the illness. Non-ergot DAs, such as pramipexole, rotigotine and ropinirole, may be...
Source: Drugs and Aging - January 9, 2019 Category: Geriatrics Source Type: research

Using Lithium in Older Age Bipolar Disorder: Special Considerations
This study found lithium to be effective in late-life mania and hypomania. Th e remaining literature examining lithium in OABD was reviewed, comprising of a number of small open-label and retrospective studies, with special considerations highlighted. In summary, there is a small yet increasing geriatric evidence base that lithium is effective in OABD. Although there can be a dverse effects with lithium, it is generally well tolerated, and there are methods to minimize these risks. Further research would strengthen the evidence base for lithium therapy in OABD. In the meantime, lithium remains the gold-standard treatment f...
Source: Drugs and Aging - January 7, 2019 Category: Geriatrics Source Type: research

Drug Therapy of Dyslipidemia in the Elderly
AbstractAbnormal lipoprotein metabolism is an important and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), which has been shown in numerous studies to lead to adverse cardiovascular outcomes. As cardiovascular disease (CVD) remains the major cause of morbidity and mortality globally, management of dyslipidemia is a key component of primary and secondary risk-reduction strategies. Because ASCVD risk increases with age, as the population ages, many more people —particularly the elderly—will meet guideline criteria for drug treatment. Statins (HMG-CoA reductase inhibitors) have an unequ...
Source: Drugs and Aging - January 7, 2019 Category: Geriatrics Source Type: research

Management of Male Lower Urinary Tract Symptoms in a Simulated, Over-the-Counter Setting: An Exploratory Study of Tamsulosin
ConclusionsOf the men interested in self-managing their LUTS, a majority had moderate-to-severe LUTS of long duration. Most men were able to appropriately self-select and use tamsulosin in concordance with DFL instructions and directions. No unexpected AEs were reported during self-directed use. With further label refinement, an over-the-counter tamsulosin option might be feasible.Trial registrationClinicalTrials.gov NCT01726270. (Source: Drugs and Aging)
Source: Drugs and Aging - January 3, 2019 Category: Geriatrics Source Type: research

Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial
The objective of this study was to determine the association of medication quality with functional abilities tested in cognitive and physical function tests.Patients and MethodsData from the prospective, randomized controlled VALFORTA trial on 409 geriatric (mean age 81.53  years) in-hospital patients were tested for associations between the FORTA score (sum of over- and under-treatment errors) on admission and cognitive and physical function tests. Univariate and multivariate linear correlations corrected for age, sex, number of medications, number of chronic condit ions, and body mass index as well as comparisons be...
Source: Drugs and Aging - December 21, 2018 Category: Geriatrics Source Type: research

Interventions to Optimise Prescribing in Older People with Dementia: A Systematic Review
ConclusionEmerging evidence suggests that interventions in older people with dementia may have positive effects on medication appropriateness and resolution of drug-related problems; however, whether optimisation of medication results in clinically meaningful outcomes remains uncertain. (Source: Drugs and Aging)
Source: Drugs and Aging - December 19, 2018 Category: Geriatrics Source Type: research

Parkinson ’s Disease in the Era of Personalised Medicine: One Size Does Not Fit All
AbstractThe concept of personalised medicine in Parkinson ’s disease has arrived where the implications of findings made in research are certain to have an increasing impact upon clinical practice. Disease heterogeneity in Parkinson’s disease has been well described and lends itself to the construct of personalised medicine where it is hypothesised tha t a greater understanding of genetic and pathophysiological contributions may underpin the sub-groups described. This in turn has driven the development of potentially individualised disease-modifying therapies where, for example, we are beginning to see treatmen...
Source: Drugs and Aging - December 17, 2018 Category: Geriatrics Source Type: research

Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia
AbstractPsychotropic medications have a high risk of serious adverse events and small effect size for changed behaviours for people with dementia. Non-pharmacological approaches are recommended as first-line treatment for changed behaviours, yet psychotropic medications remain highly prevalent in long-term aged care settings. This narrative review describes the current evidence regarding deprescribing psychotropic medications for people with dementia in long-term care. Deprescribing psychotropic medications can be achieved without harm to the person with dementia, and most people experience no withdrawal symptoms. Interven...
Source: Drugs and Aging - December 11, 2018 Category: Geriatrics Source Type: research

Contemporary Management of Heart Failure in the Elderly
AbstractThe foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction. On this ...
Source: Drugs and Aging - December 11, 2018 Category: Geriatrics Source Type: research

Discrepancy Between Equations Estimating Kidney Function in Geriatric Care: A Study of Implications for Drug Prescription
ConclusionIn acute geriatric care units, recommended drug dose adjustments are frequently discordant according to the equations used to estimate kidney function, notably for benzodiazepines, anticoagulants, and anti-microbial drugs. The consequences for treatment efficacy and safety should be investigated. (Source: Drugs and Aging)
Source: Drugs and Aging - December 6, 2018 Category: Geriatrics Source Type: research

Management of Ulcerative Colitis in the Elderly
AbstractThe incidence rate of ulcerative colitis (UC) in older patients is rising. Diagnosis of UC may be difficult in older patients as several common gastrointestinal disorders can mimic UC in these patients. Compared with younger adults, left-sided colitis is more common in older-onset UC, while rectal bleeding, abdominal pain, and extraintestinal manifestations are less common. The disease course of older-onset UC may be similar to that of adult-onset UC. The management of UC in older patients includes medical and surgical options. A majority of older UC patients are treated with 5-aminosalicylates. The underuse of imm...
Source: Drugs and Aging - December 4, 2018 Category: Geriatrics Source Type: research

Infective Endocarditis in the Elderly: Diagnostic and Treatment Options
AbstractInfective endocarditis (IE) is an uncommon, life-threatening systemic disorder with significant morbidity and persistently high mortality. The age of the peak incidence of IE has shifted from 45  years in the 1950s to 70 years at the present time, and elderly people have a five-fold higher risk of IE than the general adult population. Elderly IE patients demonstrate a higher prevalence of coagulase-negative staphylococci, enterococci andStreptococcus bovis, and lower rates of infection by viridans group streptococci. Methicillin resistance is more prevalent in elderly patients as a consequence of increase...
Source: Drugs and Aging - November 29, 2018 Category: Geriatrics Source Type: research

Medical Cannabis for Older Patients
AbstractInterest in the medicinal use of cannabis and cannabinoids is mounting worldwide. Fueled by enthusiastic media coverage, patients perceive cannabinoids as a natural remedy for many symptoms. Cannabinoid use is of particular interest for older individuals who may experience symptoms such as chronic pain, sleep disturbance, cancer-related symptoms and mood disorders, all of which are often poorly controlled by current drug treatments that may also incur medication-induced side effects. This review provides a summary of the evidence for use of cannabinoids, and medical cannabis in particular, for this age group, with ...
Source: Drugs and Aging - November 29, 2018 Category: Geriatrics Source Type: research

Aging in Primary Systemic Vasculitis: Implications for Diagnosis, Clinical Manifestations, and Management
AbstractAnti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) usually affect adults and older populations. The well  recognized clinical (i.e., granulomatosis with polyangiitis [GPA], microscopic polyangiitis, and eosinophilic GPA) and serological phenotypes (i.e., anti-MPO-ANCA, anti-PR3-ANCA and ANCA negative) within AAV differ substantially for clinical, demographic, and epidemiological features, includin g age at presentation. Whether and how aging could contribute to the clinical expression of these disease phenotypes is intriguing and still overlooked. In addition, despite...
Source: Drugs and Aging - November 28, 2018 Category: Geriatrics Source Type: research

Relation Between Delirium and Anticholinergic Drug Burden in a Cohort of Hospitalized Older Patients: An Observational Study
ConclusionsAnticholinergic drugs may influence the development of delirium due to the cumulative effect of multiple medications with modest antimuscarinic activity. However, this effect was no longer evident in multivariable logistic regression analysis, after adjustment for dementia and malnutrition. Larger, multicenter studies are required to clarify the complex relationship between drugs, anticholinergic burden and delirium in various categories of hospitalized older patients, including those with dementia and malnutrition. (Source: Drugs and Aging)
Source: Drugs and Aging - November 27, 2018 Category: Geriatrics Source Type: research

Novel Cancer Therapeutics in Geriatrics: What is Unique to the Aging Patient?
AbstractWith the worldwide trend of aging populations, the number of older adults who develop and survive cancer is likely to increase. In the last decade, oncology drug development has shifted away from conventional chemotherapeutics towards agents that can ‘target’ a driver mutation of a specific cancer or ‘unleash’ the patient’s native immune system to attack the cancer—so-called molecularly targeted therapies and immunotherapeutics. The basic algorithms of cancer treatment in elderly patients are essentially the same as in younger patien ts; however, one needs to pay exceptional atte...
Source: Drugs and Aging - November 27, 2018 Category: Geriatrics Source Type: research

Apixaban Levels in Octogenarian Patients with Non-valvular Atrial Fibrillation
AbstractBackgroundThere is a paucity of data on apixaban levels among octogenarians with non-valvular atrial fibrillation (NVAF). We aimed to compare apixaban levels between octogenarians (with and without dose reduction) and younger patients, to assess the frequency of high and above-range drug levels.MethodsA cross-sectional, prospective study of 80 patients treated with apixaban for NVAF was conducted. Apixaban levels were compared among octogenarians treated with 5 mg twice daily (bid), octogenarians with appropriately reduced dose (2.5  mg bid), octogenarians with inappropriately reduced dose and younger patients (age
Source: Drugs and Aging - November 21, 2018 Category: Geriatrics Source Type: research

Acknowledgment to Referees
(Source: Drugs and Aging)
Source: Drugs and Aging - November 21, 2018 Category: Geriatrics Source Type: research

Dabigatran Versus Rivaroxaban for Secondary Stroke Prevention in Patients with Atrial Fibrillation Rehabilitated in Skilled Nursing Facilities
ConclusionsIn older adults treated with direct-acting oral anticoagulants after ischemic stroke, outcome rates varied considerably by drug and dosage. (Source: Drugs and Aging)
Source: Drugs and Aging - November 13, 2018 Category: Geriatrics Source Type: research

Comment on: A Systematic Review and Meta-Analyses of the Association Between Anti-hypertensive Classes and the Risk of Falls Among Older Adults
(Source: Drugs and Aging)
Source: Drugs and Aging - November 13, 2018 Category: Geriatrics Source Type: research

Authors ’ Reply to Kahlaee et al: “A Systematic Review and Meta-Analyses of the Association Between Anti-hypertensive Classes and the Risk of Falls Among Older Adults”
(Source: Drugs and Aging)
Source: Drugs and Aging - November 13, 2018 Category: Geriatrics Source Type: research

Influenza Vaccination in Older Adults: Recent Innovations and Practical Applications
AbstractInfluenza can lead to serious illness, particularly for older adults. In addition to short-term morbidity and mortality during the acute infection, recovery can be prolonged and often incomplete. This may lead to persistent declines in health and function, including catastrophic disability, which has dramatic implications for the well-being and support needs of older adults and their caregivers. All of this means that prevention of infection and effective treatment when illness has occurred are of paramount importance. In this narrative review, we discuss the effectiveness of influenza vaccines for the prevention o...
Source: Drugs and Aging - November 9, 2018 Category: Geriatrics Source Type: research

Serum Concentrations and Elimination Rates of Direct-Acting Oral Anticoagulants (DOACs) in Older Hip Fracture Patients Hospitalized for Surgery: A Pilot Study
ConclusionThis pilot study indicates that older patients prone to hip fracture are at risk of being exposed to therapeutic serum concentrations of DOACs during surgery due to reduced drug elimination rates. The observation that almost 50% of the patients had therapeutic concentrations at surgery should be investigated further regarding safety of DOAC use in this frail elderly population. (Source: Drugs and Aging)
Source: Drugs and Aging - November 9, 2018 Category: Geriatrics Source Type: research

Safety, Tolerability and Efficacy of Eslicarbazepine Acetate as Adjunctive Therapy in Patients Aged  ≥ 65 Years with Focal Seizures
ConclusionESL taken once daily (400 –1200 mg) as adjunctive therapy in patients aged ≥ 65 years was found to be safe, well tolerated and efficacious (EudraCT number: 2009-012587-14). (Source: Drugs and Aging)
Source: Drugs and Aging - November 1, 2018 Category: Geriatrics Source Type: research

Is the Drug Burden Index Related to Declining Functional Status at Follow-up in Community-Dwelling Seniors Consulting for Minor Injuries? Results from the Canadian Emergency Team Initiative Cohort Study
AbstractBackgroundThe Canadian Emergency Team Initiative (CETI) cohort showed that minor injuries like sprained ankles or small fractures trigger a downward spiral of functional decline in 16% of independent seniors up to 6  months post-injury. Such seniors frequently receive medications with sedative or anticholinergic properties. The Drug Burden Index (DBI), which summarises the drug burden of these specific medications, has been associated with decreased physical and cognitive functioning in previous research.ObjectivesWe aimed to assess the contribution of the DBI to functional decline in the CETI cohort.MethodsCE...
Source: Drugs and Aging - October 31, 2018 Category: Geriatrics Source Type: research

Recombinant Zoster Vaccine (Shingrix ® ): A Review in Herpes Zoster
AbstractShingrix® is a recombinant zoster vaccine (RZV) that contains a varicella zoster virus glycoprotein  E antigen and the AS01B adjuvant system. The subunit vaccine is approved for the prevention of herpes zoster (HZ) [EU, USA, Japan, Canada and Australia] and postherpetic neuralgia (PHN) [EU and Australia] in adults aged  ≥ 50 years. In the pivotal trials in adults aged ≥ 50 years (ZOE-50) and ≥ 70 years (ZOE-70), RZV significantly reduced the risk of HZ and PHN. Its protective efficacy waned minimally over 4 years and was well preserved in ...
Source: Drugs and Aging - October 29, 2018 Category: Geriatrics Source Type: research

Authors ’ Reply to Stefani: “Efficacy and Safety of Analgesic Treatment for Depression in People with Advanced Dementia: Randomised, Multicentre, Double-Blind, Placebo-Controlled Trial (DEP.PAIN.DEM)”
(Source: Drugs and Aging)
Source: Drugs and Aging - October 27, 2018 Category: Geriatrics Source Type: research

Comment on: “Efficacy and Safety of Analgesic Treatment for Depression in People with Advanced Dementia: Randomised, Multicentre, Double-Blind, Placebo-Controlled Trial (DEP.PAIN.DEM)”
(Source: Drugs and Aging)
Source: Drugs and Aging - October 27, 2018 Category: Geriatrics Source Type: research

Adherence of Elderly Patients with Cardiovascular Disease to Statins and the Risk of Exacerbation of Chronic Obstructive Pulmonary Disease: Evidence from an Italian Real-World Investigation
ConclusionsIn a real-world setting, we observed evidence that adherence to statin therapy markedly reduced the risk of chronic obstructive pulmonary disease exacerbations in elderly patients with co-existing chronic obstructive pulmonary disease and cardiovascular disease. Given the limited and controversial evidence from trials, more randomised controlled trials are urgently needed to better examine the potential benefits of statins as adjunct therapy in chronic obstructive pulmonary disease. (Source: Drugs and Aging)
Source: Drugs and Aging - October 26, 2018 Category: Geriatrics Source Type: research

Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly
AbstractDrug-induced parkinsonism (DIP) and tardive dyskinesia (TD) are iatrogenic consequences of antidopaminergic drugs. Both are particularly prevalent among the elderly and those with dementia. However, despite their prevalence, these disorders are often overlooked. Both entities share risk factors, physiopathological mechanisms and, to some degree, therapeutic approaches. Withdrawing the causal agent, reducing the dose or switching to a less potent antidopaminergic drug should be the first therapeutic options. Here we review both entities and emerging therapies including the recently approved drugs deutetrabenazine an...
Source: Drugs and Aging - October 25, 2018 Category: Geriatrics Source Type: research

Efficacy of a Standardized Oral Vitamin D Dosing Regimen in Nursing Home Residents
AbstractBackgroundThe prevalence of vitamin D deficiency in nursing home residents ranges from 79% to 98%.ObjectivesThe aim of this cross-sectional observational study in somatic and psychogeriatric nursing home residents was to determine the efficacy of a standardized oral vitamin D dosing regimen (VDDR) consisting of a loading dose (LD) of cholecalciferol 200,000  IU followed by a maintenance dose (MD) of 100,000 IU every 13 weeks in obtaining and maintaining an adequate and safe vitamin D trough level (VDTL), defined as 75–220 nmol/L (reference range).MethodsBlood samples of nursing home reside...
Source: Drugs and Aging - October 22, 2018 Category: Geriatrics Source Type: research

Adjunctive Therapies in Parkinson ’s Disease: How to Choose the Best Treatment Strategy Approach
AbstractEnd-of-dose motor fluctuations are regarded as one of the core troublesome symptoms by patients with Parkinson ’s disease (PD). Treatment of levodopa (l-dopa)-induced motor fluctuations is still an unmet medical need.l-dopa is the gold standard in the treatment of motor PD symptoms; notwithstanding, a wide range of adjunct therapies are currently available for the treatment of end-of-dose motor fluctuations. Additionally, device-aided therapies, such as deep brain stimulation,l-dopa-carbidopa intestinal gel infusion, and on-demand injection or continuous apomorphine infusion, may be considered when oral treat...
Source: Drugs and Aging - October 15, 2018 Category: Geriatrics Source Type: research

Systemic Estrogen Use and Discontinuation After Alzheimer ’s Disease Diagnosis in Finland 2005–2012: A Nationwide Exposure-Matched Cohort Study
This study included an exposure-matched cohort of all Finnish community-dwelling women who received a clinically verified diagnosis of AD in 2005 –2011 (N = 46,116; index cases) and an equally sized matched comparison cohort without AD. Follow-up began on the matching date (date of the AD diagnosis of the index case). Data on systemic estrogen use were obtained from the prescription register. Use initiation and discontinuation were assessed.ResultsAltogether 3.1% of women with AD and 4.3% of women without AD used estrogen during the follow-up period. Only  
Source: Drugs and Aging - October 13, 2018 Category: Geriatrics Source Type: research

Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease: A Secondary Analysis of the FINALEX Study
We examined the incidence rate ratios (IRRs) for falls among both non-users and users of various FRDs (antihypertensives, psychotropics, drugs with anticholinergic properties [DAPs]) in both control and combined intervention groups.ResultsBetween the intervention and control groups, there was no difference in the number of falls among those without antihypertensives or psychotropics. In the intervention group taking antihypertensives, the IRR was 0.5 falls/person-year (95% confidence interval [CI] 0.4 –0.6), while in the control group, the IRR was 1.5 falls/person-year (95% CI 1.2–1.8) [p 
Source: Drugs and Aging - October 13, 2018 Category: Geriatrics Source Type: research

Evidence-Based Management of Diabetes in Older Adults
AbstractThe number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower blood glucose levels and the optimal method of doing so, the goals of diabetes control in older people must be individualized. If the patient requires insulin therapy, the newer insulins, with their improved pharmacodynamic consistency and reduced risk of hypoglycemia, should be preferred. Several ora...
Source: Drugs and Aging - October 10, 2018 Category: Geriatrics Source Type: research