American Journal Geriatric Pharmacotherapy最新文献

{"title":"Medication Discrepancy and Potentially Inappropriate Medication in Older Chinese-American Home-Care Patients After Hospital Discharge","authors":"Sophia H. Hu PhD, RN ,&nbsp;Elizabeth Capezuti PhD, RN, FAAN ,&nbsp;Janice B. Foust PhD, RN ,&nbsp;Marie P. Boltz PhD, RN, GNP-BC ,&nbsp;Hongsoo Kim PhD, MPH, RN","doi":"10.1016/j.amjopharm.2012.08.001","DOIUrl":"10.1016/j.amjopharm.2012.08.001","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p><span>This cross-sectional study was conducted with a sample of older Chinese Americans from a large certified nonprofit home-care agency in New York City from June 2010 to July 2011. PIMs were identified by using 2002 diagnosis-independent Beers criteria. MDs were identified by comparing the differences between hospital discharge medication order and home-care admission medication order. Prevalence of PIMs and MDs and their relationship was determined. </span>Logistic regression<span> examined the relationship between hospitalization and patient characteristics with PIMs and MDs.</span></p></div><div><h3>Results</h3><p>The sample consisted of 82 older Chinese-American home-care patients. Twenty (24.3%) study participants were prescribed at least one PIM at hospital discharge. Fifty-one (67.1%) study participants experienced at least one MD. A positive correlation was found between the occurrence of PIMs and MDs (<em>r = 0</em>.22; <em>P</em> = 0.05). Number of medications was the only significant factor associated with both PIMs and MDs. In addition, older age and more hospitalization days were associated with PIMs.</p></div><div><h3>Conclusions</h3><p>The evident prevalence of PIMs and MDs supports the practice of evaluating the appropriateness of medications while reconciling inconsistencies in medication regimens. The number of medications was the only factor associated with both PIMs and MDs, underscoring the need to address polypharmacy as a multifaceted threat to patient health.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 5","pages":"Pages 284-295"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30878866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Statins on Acute and Long-Term Outcome After Ischemic Stroke in the Elderly","authors":"Clara Hjalmarsson PhD ,&nbsp;Lena Bokemark PhD ,&nbsp;Karin Manhem PhD ,&nbsp;Kirsten Mehlig PhD ,&nbsp;Björn Andersson PhD","doi":"10.1016/j.amjopharm.2012.09.001","DOIUrl":"10.1016/j.amjopharm.2012.09.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Although treatment with </span>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.</p></div><div><h3>Objective</h3><p>The aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population.</p></div><div><h3>Methods</h3><p><span>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 </span>acute ischemic stroke<span>. The effect of statin treatment on survival was examined using the Cox proportional hazard model, after adjusting for relevant covariates.</span></p></div><div><h3>Results</h3><p>Statins did not decrease stroke severity and did not improve 30-day survival. However, both the 12-month survival (hazard ratio = 0.33; 95% CI, 0.20–to 0.54; <em>P</em> &lt; 0.001) and the 12-month functional outcome (odds ratio = 2.09; 95% CI, 1.25–3.52; <em>P</em> = 0.005) were significantly better in the group treated with statins.</p></div><div><h3>Conclusions</h3><p>Significantly better survival and functional outcome were noted with poststroke statins at the end of the 12-month follow-up period. Statins seem to provide beneficial effects for the long-term functional outcome and survival in the elderly.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 5","pages":"Pages 313-322"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30974771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacist- Versus Physician-Initiated Admission Medication Reconciliation: Impact on Adverse Drug Events","authors":"Kari A. Mergenhagen PharmD ,&nbsp;Sharon S. Blum PharmD ,&nbsp;Anne Kugler PharmD ,&nbsp;Elayne E. Livote PhD ,&nbsp;Jonathan R. Nebeker MS, MD ,&nbsp;Michael C. Ott PharmD ,&nbsp;Daniel Signor BA ,&nbsp;Soojin Sung PharmD ,&nbsp;Jessica Yeh PharmD ,&nbsp;Kenneth S. Boockvar MD, MS","doi":"10.1016/j.amjopharm.2012.06.001","DOIUrl":"10.1016/j.amjopharm.2012.06.001","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p><span>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. </span>Adverse drug events (ADEs) and a 72-hour medication-prescribing risk score were ascertained by research pharmacists for all admitted patients by structured record review. Multivariable models were tested for intervention effect, accounting for quasi-experimental design and clustered observations, and were adjusted for patient and encounter covariates.</p></div><div><h3>Results</h3><p>Pharmacists completed the MR process in 102 admissions and physicians completed the process in 116 admissions. In completing the MR process, pharmacists documented statistically more admission medication changes than physicians (3.6 vs 0.8; <em>P</em> &lt; 0.001). The adjusted odds of an ADE caused by an admission prescribing change with pharmacist-initiated MR compared with a physician-initiated MR were 1.04 with a 95% CI of 0.53 to 2.0. The adjusted odds of an ADE caused by an admission prescribing change that was a prescribing error with pharmacist-initiated MR compared with a physician-initiated MR were 0.38 with a confidence interval of 0.14 to 1.05. No difference was observed in 72-hour prescribing risk score (coefficient = 0.10; 95% CI, −0.54 to 0.75).</p></div><div><h3>Conclusion</h3><p>MR performed by pharmacists versus physicians was more comprehensive and was followed by lower odds of ADEs from admission prescribing errors but with similar odds of all types of ADEs. Further research is warranted to examine how MR tasks may be optimally divided among clinicians and the mechanisms by which MR affects the likelihood of subsequent ADEs. <span>ClinicalTrials.gov</span><svg><path></path></svg> identifier: <span>NCT00370916</span><svg><path></path></svg>.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 242-250"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30779420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Family Caregivers on Potentially Inappropriate Medication Use in Noninstitutionalized Older Adults With Dementia","authors":"Joshua M. Thorpe PhD, MPH ,&nbsp;Carolyn T. Thorpe PhD, MPH ,&nbsp;Korey A. Kennelty PharmD, MS ,&nbsp;Walid F. Gellad MD, MPH ,&nbsp;Richard Schulz PhD","doi":"10.1016/j.amjopharm.2012.05.001","DOIUrl":"10.1016/j.amjopharm.2012.05.001","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>We conducted a secondary data analysis of the baseline wave of the Resources for Enhancing Alzheimer's Caregiver's Health study. The sample comprised 566 persons with dementia aged 65 and older and their coresiding family caregiver. PIM was defined using the 2003 Beers criteria and was examined in both dementia patients and their caregivers. Caregiver and patient risk factors included a range of sociodemographic and health variables.</p></div><div><h3>Results</h3><p>In dementia patients, 33% were taking at least 1 PIM, and 39% of their caregivers were also taking a PIM. In fully adjusted models, the following caregiver factors were associated with an increased risk of dementia patient PIM use: caregiver's own PIM use, spouse caregivers, Hispanic caregivers, and greater number of years that the caregiver has lived in the United States. Increased caregiver age was associated with a decreased risk of PIM use in patients.</p></div><div><h3>Conclusions</h3><p>PIM use may be higher in dementia patients and their informal caregivers compared with the general older adult population. Further, patterns of medication use in 1 member of the dyad may influence PIM risk in the other dyad member. These results suggest that interventions to increase appropriate medication use in dementia patients and their caregivers should target both members of the dyad and target over-the-counter agents along with prescription medications.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 230-241"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30678856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA Drug Safety Communications: A Narrative Review and Clinical Considerations for Older Adults","authors":"Zachary A. Marcum PharmD, MS ,&nbsp;Joseph P. Vande Griend PharmD ,&nbsp;Sunny A. Linnebur PharmD","doi":"10.1016/j.amjopharm.2012.05.002","DOIUrl":"10.1016/j.amjopharm.2012.05.002","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Objective</h3><p>To summarize 4 new FDA drug safety communications by describing the evidence supporting the risks and the clinical implications for older adults.</p></div><div><h3>Methods</h3><p>The FDA Web site was reviewed for new drug safety communications from May 2011 to April 2012 that would be relevant to older adults. Approved labeling for each drug or class was obtained from the manufacturer, and PubMed was searched for primary literature that supported the drug safety concern.</p></div><div><h3>Results</h3><p><span><span>FDA drug safety communications for 4 drugs were chosen because of the potential clinical importance in older adults. A warning for citalopram<span> was made because of potential problems with QT prolongation </span></span>in patients<span> taking less than 40 mg per day. The evidence suggests minor changes in QT interval. Given the flat dose–response curve in treating depression with citalopram, the new 20-mg/d maximum dose in older adults is sensible. Another warning was made for proton pump inhibitors (PPIs) and an increased risk of </span></span><em>Clostridium difficile</em> infection. A dose–response relationship was found for this drug risk. With <em>C. difficile</em><span><span> infections on the rise in older adults, along with other safety risks of PPI therapy<span>, PPIs should only be used in older adults indicated for therapy for the shortest duration possible. In addition, a warning about dabigatran was made. There is strong evidence from a large </span></span>clinical trial<span><span><span>, as well as case reports, of increased bleeding risk in older adults taking dabigatran, especially in older adults with decreased renal function. This medication should be used with caution in older adults. Finally, several warnings were made about statins. Routine periodic monitoring of </span>liver enzymes does not appear to be effective in detecting or preventing serious liver injury from </span>statin use; thus, liver enzymes are no longer recommended to be routinely monitored. Statin-induced cognitive changes are rare, and insufficient evidence is currently available to establish causality. Statins appear to moderately increase the risk of developing diabetes (versus placebo), and regular screening for diabetes should be considered, especially for patients taking high-dose statins and patients with multiple risk factors for diabetes.</span></span></p></div><div><h3>Conclusion</h3><p>FDA drug safety communications incorporate complex ","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 264-271"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.05.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30678855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking Beyond Polypharmacy: Quantification of Medication Regimen Complexity in the Elderly","authors":"Nariman Mansur PharmMs ,&nbsp;Avraham Weiss MD ,&nbsp;Yichayaou Beloosesky MD","doi":"10.1016/j.amjopharm.2012.06.002","DOIUrl":"10.1016/j.amjopharm.2012.06.002","url":null,"abstract":"<div><h3>Background</h3><p><span>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 </span>after discharge of elderly patients has not been studied.</p></div><div><h3>Objective</h3><p>Our aim was to test the convergent, discriminant, and predictive validity of the MRCI in older hospitalized patients with varying functional and cognitive levels.</p></div><div><h3>Methods</h3><p>We retrospectively applied the MRCI to the medication regimen of 212 hospitalized patients and assessed its validity.</p></div><div><h3>Results</h3><p>The mean (SD) MRCI scores for medication regimens and number of medications at discharge were 30.27 (13.95) and 5.95 (2.40), respectively. The MRCI scores were strongly correlated with the number of medications (<em>r</em> <!-->=<!--> <!-->0.94, <em>P</em> <!-->&lt;<!--> <!-->0.001) and the number of daily doses (<em>r</em> <!-->=<!--> <!-->0.87, <em>P</em> <!-->&lt;<!--> <span>0.001) and increased as the number of medications taken ≥3 times daily increased (27.35, 34.45, and 43.00 for none, 1, and 2 drugs, respectively; </span><em>P</em> <!-->&lt;<!--> <!-->0.001). Positive correlations were observed between the Cumulative Illness Rating Scale–Geriatrics score and both the number of medications and the MRCI score (<em>r</em> <!-->=<!--> <!-->0.40, <em>r</em> <!-->=<!--> <!-->0.46, <em>P</em> <!-->&lt;<!--> <!-->0.001, respectively). No relationship was found between MRCI scores and the number of medications and age, sex, and postdischarge medication modifications. Patients nonadherent to at least 1 drug were discharged with a higher MRCI score and higher number of medications compared with medication-compliant patients (33.3 and 7.0 vs 27 and 5.8, respectively; <em>P</em> <!-->&lt;<!--> <!-->0.01). An inverse correlation was found between overall adherence 1 month after discharge and the MRCI score (<em>r</em> <!-->=<!--> <!-->−0.188, <em>P</em> <!-->= 0.028); however, no such correlation was found regarding the number of medications at discharge.</p></div><div><h3>Conclusions</h3><p>The MRCI showed satisfactory validity and good evidence of classifying regimen complexity over a simple medication count. The MRCI demonstrated application in clinical research and practice in the elderly. However, more studies are needed to investigate its advantage over the number of medications for identifying patients with complex medication regimens and directing interventions to simplify their medication regimen complexity.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 223-229"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.06.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30730722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Year in Review: New Drugs for Older Adults in 2011","authors":"Joseph P. Vande Griend PharmD ,&nbsp;Zachary A. Marcum PharmD, MS ,&nbsp;Sunny A. Linnebur PharmD","doi":"10.1016/j.amjopharm.2012.05.003","DOIUrl":"10.1016/j.amjopharm.2012.05.003","url":null,"abstract":"<div><h3>Background</h3><p><span>New drugs approved by the Food and Drug Administration (FDA) may offer tremendous clinical advances by providing health care providers with new </span>treatment strategies. However, additional care must be taken for safe and effective use of these new agents by older adults.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>The FDA Web site was reviewed for new drug approvals from January through December 2011. Approved labeling for each drug was obtained from the manufacturer's Web site and PubMed was searched for primary literature published between 1967 and 2012.</p></div><div><h3>Results</h3><p><span><span>Rivaroxaban<span>, an oral factor Xa inhibitor, is approved for once-daily use in treatment of </span></span>nonvalvular atrial fibrillation<span><span> and deep vein thrombosis prophylaxis after replacement of a hip or knee. Drug interactions and renal function must be considered when prescribing this drug to older adults. </span>Fidaxomicin is an oral anti-infective approved for the treatment of </span></span><em>Clostridium difficile</em><span><span>-associated diarrhea. It has minimal oral absorption<span> or side effects, no relevant drug interactions, but a very high cost. It is a treatment option after failure of oral metronidazole<span><span><span> and oral vancomycin. </span>Roflumilast is a selective inhibitor of </span>phosphodiesterase 4 and is approved to reduce the risk of </span></span></span>chronic obstructive pulmonary disease<span><span><span> (COPD) exacerbations in patients with severe COPD and a history of exacerbations. It is recommended as a second or alternative choice combined with a long-acting </span>bronchodilator in patients at high risk for hospitalization. </span>Indacaterol is an inhaled long-acting β-agonist approved for COPD maintenance. It is administered once daily, which may improve adherence in older adults compared with currently available twice-daily agents.</span></span></p></div><div><h3>Conclusions</h3><p>Four new drugs approved in 2011 applicable to the geriatric population are presented. Clinicians must consider the available evidence, cost, drug–drug interactions, renal function, pharmacokinetic/pharmacodynamic differences, and patient preferences when considering prescribing these agents to older adults.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 258-263"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30677472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticholinergic Drugs and Functional Outcomes in Older Patients Undergoing Orthopaedic Rehabilitation","authors":"Sejlo Koshoedo MB, BS ,&nbsp;Roy L. Soiza MB ChB ,&nbsp;Rajib Purkayastha MB, BS ,&nbsp;Arduino A. Mangoni MD, PhD","doi":"10.1016/j.amjopharm.2012.06.003","DOIUrl":"10.1016/j.amjopharm.2012.06.003","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>Data on clinical characteristics, full medication, anticholinergic drug exposure (total number of anticholinergic drugs [tAD] and Anticholinergic Risk Scale [ARS] score), and Barthel index<span> (BI) score were collected on admission and discharge in a consecutive series of 117 older patients (age 79 [7] years) admitted to the orthopaedic rehabilitation unit of a teaching hospital between July 2010 and March 2011. Outcome measures were BI changes (BI on discharge – BI on admission) during rehabilitation (primary outcome) and length of stay (secondary outcome).</span></p></div><div><h3>Results</h3><p>Anticholinergic drugs were prescribed in 38 patients (32.5%). Median and interquartile range for tAD = 0 (0–1); for ARS = 0 (0–1). Poisson regression showed that higher tAD (incidence rate ratio [IRR] = 0.92; 95% CI, 0.88–0.97; <em>P</em> = 0.003) and ARS scores (IRR = 0.97; 95% CI, 0.95–0.99; <em>P</em> = 0.008) on admission independently predicted lower BI changes. Being a woman (IRR = 0.87; 95% CI, 0.78–0.97; <em>P</em> = 0.01), lower Abbreviated Mental Test scores <strong>(</strong>IRR = 0.94; 95% CI, 0.91–0.97; <em>P</em> &lt; 0.001), and lower BI on admission (IRR = 0.98; 95% CI, 0.97–0.98; <em>P</em> &lt; 0.001), but not tAD or ARS scores, independently predicted increasing length of stay.</p></div><div><h3>Conclusions</h3><p>Higher anticholinergic drug exposure on admission independently predicts reduced functional outcomes, but not length of stay, in older patients undergoing orthopaedic rehabilitation.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 4","pages":"Pages 251-257"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.06.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30761108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication Adherence in Older Adults With Cognitive Impairment: A Systematic Evidence-Based Review","authors":"Noll L. Campbell PharmD ,&nbsp;Malaz A. Boustani MD, MPH ,&nbsp;Elaine N. Skopelja MALS, AHIP ,&nbsp;Sujuan Gao PhD ,&nbsp;Fred W. Unverzagt PhD ,&nbsp;Michael D. Murray PharmD, MPH","doi":"10.1016/j.amjopharm.2012.04.004","DOIUrl":"10.1016/j.amjopharm.2012.04.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple </span>medical problems in older adults.</p></div><div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>A search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Studies included older adults with a diagnosis of cognitive impairment of any degree (mild cognitive impairment or mild, moderate, or severe dementia). To identify barriers to adherence, we reviewed observational studies. To identify relevant interventions, we reviewed clinical trials targeting medication adherence in cognitively impaired older adults. We excluded studies lacking a measure of medication adherence or lacking an assessment of cognitive function, case reports or series, reviews, and those focusing on psychiatric disorders or infectious diseases. Population demographics, baseline cognitive function, medication adherence methods, barriers to adherence, and prospective intervention methodologies were extracted.</p></div><div><h3>Results</h3><p>The initial search identified 594 articles. Ten studies met inclusion criteria for barriers to adherence and three met inclusion criteria for interventional studies. Unique barriers to adherence included understanding new directions, living alone, scheduling medication administration into the daily routine, using potentially inappropriate medications, and uncooperative patients. Two studies evaluated reminder systems and showed no benefit in a small group of participants. One study improved adherence through telephone and televideo reminders at each dosing interval. The results of the review are limited by reviewing only published articles, missing barriers or interventions due to lack of subgroup analysis, study selection and extraction completed by 1 reviewer, and articles with at least an abstract published in English.</p></div><div><h3>Conclusions</h3><p>The few studies identified limit the assessment of barriers to medication adherence in the cognitively impaired population. Successful interventions suggest that frequent human communication as reminder systems are more likely to improve adherence than nonhuman reminders.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 165-177"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.04.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30660244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Post–Traumatic Memories Triggered by Donepezil in a Dose-Dependent Pattern","authors":"Michael L. Wolff MD","doi":"10.1016/j.amjopharm.2012.03.001","DOIUrl":"10.1016/j.amjopharm.2012.03.001","url":null,"abstract":"<div><h3>Background</h3><p>This case report describes a new adverse drug event<span><span> due to use of donepezil in a patient with probable </span>Alzheimer's Disease.</span></p></div><div><h3>Case summary</h3><p>While receiving a 10-mg dose of donepezil nightly, an 87-year old veteran of World War II experienced irrepressible memories of a kamikaze strike. This symptom did not occur at a 5-mg dose of donepezil and resolved with downward titration of this agent.</p></div><div><h3>Conclusions</h3><p>This sequence of dosage and symptoms suggests acetylcholinesterase inhibition was the trigger for release of these memories, which are otherwise mostly chronically repressed in this individual.</p></div>","PeriodicalId":50811,"journal":{"name":"American Journal Geriatric Pharmacotherapy","volume":"10 3","pages":"Pages 219-222"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.amjopharm.2012.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30525630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}