The PROMISING Project: A Pilot Study to Improve Geriatric Care Through a Pharmacist-Led Psychotropic Stewardship Program
ConclusionThe implementation of a pharmacist-led psychotropic medication stewardship program on surgical units in our hospital is feasible and is a promising approach to improve geriatric care. (Source: Drugs and Aging)
Source: Drugs and Aging - September 27, 2023 Category: Geriatrics Source Type: research

Crushed Tablet Administration for Patients with Dysphagia and Enteral Feeding: Challenges and Considerations
AbstractDysphagia is increasingly common in older adults; it is especially prevalent in long-term care settings. Patients with dysphagia likely require pharmacologic treatment for multiple comorbidities but may find it difficult or impossible to swallow oral medications. Administering crushed medications mixed with a soft food or liquid vehicle, or via a feeding tube, is a common strategy to circumvent swallowing difficulties in patients with dysphagia. However, inappropriate medication use and improper crushing technique can reduce the medication dose a patient receives, alter medication pharmacokinetics and pharmacodynam...
Source: Drugs and Aging - September 14, 2023 Category: Geriatrics Source Type: research

Systematic Review and Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults: An Update
ConclusionInterventions significantly and substantially reduced the risk of ADRs and serious ADRs in older adults. Future research should examine whether effectiveness of interventions vary across health care settings to identify those most likely to benefit. Implementation of successful interventions in health care systems may improve medication safety in older patients. (Source: Drugs and Aging)
Source: Drugs and Aging - September 13, 2023 Category: Geriatrics Source Type: research

Secular Trends in Central Nervous System-Active Polypharmacy Among Serial Cross-Sections of US Adults, 2009 –2020
ConclusionsCNS-active medications are increasingly common, particularly gabapentin, and use of any CNS-active medication increased by 12%. Numerous CNS-active classes also increased in older adults throughout the years. Increasing suboptimal medication use highlight the need for further investigation into causes for potentially inappropriate prescribing, particularly for older adults. (Source: Drugs and Aging)
Source: Drugs and Aging - September 11, 2023 Category: Geriatrics Source Type: research

Psychiatric Adverse Events of Acetylcholinesterase Inhibitors in Alzheimer ’s Disease and Parkinson’s Dementia: Systematic Review and Meta-Analysis
ConclusionsOur findings suggest that AChEI therapy may negatively impact psychological health, and careful monitoring of new psychiatric symptoms is warranted. Lowering the dose may resolve some psychiatric adverse events, as may switching to galantamine in the case of insomnia.Clinical Trial RegistrationThe study was pre-registered on PROSPERO (CRD42021258376). (Source: Drugs and Aging)
Source: Drugs and Aging - September 8, 2023 Category: Geriatrics Source Type: research

Methodological Considerations for Describing Medication Changes in Relation to Clinical Events and Death: An Applied Example in Patients with Type 2 Diabetes and Cancer
ConclusionsMedication changes in relation to a cancer diagnosis were frequent and correlated to the length of survival. The results showcase the challenges and limited clinical utility of anchoring analyses on events or death. While the former diluted the results by averaging changes across patients with vastly different clinical courses, the latter leveraged information unavailable to the treating clinicians. While medication changes were common near death, preventive medications were often used until death. (Source: Drugs and Aging)
Source: Drugs and Aging - September 1, 2023 Category: Geriatrics Source Type: research

The Impact of Polypharmacy on Management of Lower Urinary Tract Symptoms in Parkinson ’s Disease
AbstractLower urinary tract (LUT) symptoms are a common presentation of autonomic dysfunction in Parkinson ’s disease (PD). Symptoms significantly impact quality of life and are associated with worsening of motor symptoms and increased risk for falls. Different medical co-morbidities can often contribute to LUT symptoms, and a thorough evaluation therefore becomes essential. The effects of medications used for Parkinson’s disease and other co-existing medical co-morbidities on LUT symptoms is often underestimated. Treatment options include behavioural therapy, oral agents such as antimuscarinic and beta-3 receptor agon...
Source: Drugs and Aging - August 31, 2023 Category: Geriatrics Source Type: research

Discontinuation of Loop Diuretics in Older Patients with Chronic Stable Heart Failure: A Narrative Review
AbstractLoop diuretics (LDs) represent the cornerstone treatment for relieving pulmonary congestion in patients with heart failure (HF). Their benefit is well-recognized in the short term because of their ability to eliminate fluid retention. However, long term, they could adversely influence prognosis due to activation of the neurohumoral mechanism, particularly in older, frail patients. Moreover, the advent of new drugs capable of improving outcomes and reducing pulmonary and systemic congestion signs in HF emphasizes the possibility of a progressive reduction and discontinuation of LD treatment. Nevertheless, few studie...
Source: Drugs and Aging - August 25, 2023 Category: Geriatrics Source Type: research

Anticholinergic Burden and Cognitive Impairment in Nursing Homes: A Comparison of Four Anticholinergic Scales
ConclusionsThe cumulative effect of medications with modest antimuscarinic activity may influence the cognitive performance of NH residents. The anticholinergic burden measured with the ACB scale should help identify NH residents who may benefit from reducing the anticholinergic burden.A clear direct relationship between anticholinergic burden and cognitive impairment was found only for the ACB Scale. (Source: Drugs and Aging)
Source: Drugs and Aging - August 24, 2023 Category: Geriatrics Source Type: research

Efficacy and Safety of Dupilumab in Older Patients (Aged 80 Years and Above) with Atopic Dermatitis: A Prospective Study
ConclusionsDupilumab treatment showed significant efficacy in improving atopic dermatitis symptoms in patients aged 80 years and above with a high level of safety. Larger long-term clinical trials are needed to validate these results and provide further evidence for the use of dupilumab in older patients with atopic dermatitis. (Source: Drugs and Aging)
Source: Drugs and Aging - August 23, 2023 Category: Geriatrics Source Type: research

Theoretical Underpinnings of a Model to Reduce Polypharmacy and Its Negative Health Effects: Introducing the Team Approach to Polypharmacy Evaluation and Reduction (TAPER)
ConclusionsWe discuss how TAPER maps to address the specific patient-level, provider-level, and system-level barriers to deprescribing and aligns with three commonly used models and frameworks in medicine (the chronic care model, minimally disruptive medicine, the cumulative complexity model). We also describe how TAPER maps onto primary care principles, ultimately providing a description of the development of TAPER and a conceptualisation of the potential mechanisms by which TAPER reduces polypharmacy and its associated harms. (Source: Drugs and Aging)
Source: Drugs and Aging - August 21, 2023 Category: Geriatrics Source Type: research

A Review of Therapeutics for Treatment-Resistant Depression in the Older Adult
AbstractOne-third of older adults with depression meet criteria for treatment resistance, typically defined as a lack of response to two or more adequate trials of an antidepressant. Treatment resistance contributes to an unfavorable prognosis, compromised medical outcomes, heightened disability, accelerated cognitive decline, and an elevated risk of developing dementia. Despite this significant morbidity, evidence is sparse for how to proceed with treatment in this population. Non-pharmacologic therapy (e.g., diet, psychotherapy) can be utilized as adjunctive therapy, despite little published evidence of benefit, given th...
Source: Drugs and Aging - August 18, 2023 Category: Geriatrics Source Type: research

Hypertension Treatment in Frail Older Adults: A Systematic Review and Appraisal of Guidelines
ConclusionsThere were considerable variations in methodology and reporting quality across the 13 included hypertension guidelines. Furthermore, the depth and breadth of antihypertension treatment recommendations for frail older patients were varied and inconsistent. Further trials exploring optimal treatment are urgently required to promote the development of specific guidelines for managing frail older hypertensive patients. (Source: Drugs and Aging)
Source: Drugs and Aging - August 18, 2023 Category: Geriatrics Source Type: research

Evaluation and Treatment of Acute Trauma Pain in Older Adults
This article is dedicated to the management of acute trauma pain in older adults. It aims to highlight the notable clinical challenges of managing older trauma patients compared with their younger counterparts. It offers an overview of the evidence and practical opinion on the merits and drawbacks of commonly used analgesics, as well as more novel and emerging analgesic adjuncts. A search of Medline (Ovid, from inception to 7 November 2022) was conducted by a medical librarian to identify  relevant articles using keyword and subject heading terms for trauma, pain, older adults and analgesics. Results were limited to artic...
Source: Drugs and Aging - August 11, 2023 Category: Geriatrics Source Type: research

Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article
AbstractBenign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient ’s quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive ov...
Source: Drugs and Aging - August 9, 2023 Category: Geriatrics Source Type: research