The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Sep 2007
Clinical TrialReport on an open-label prospective study of divalproex sodium for the behavioral and psychological symptoms of dementia as monotherapy and in combination with second-generation antipsychotic medication.
Studies of pharmacotherapy for agitation in dementia have primarily been limited to single-drug trials and have not determined if some forms of agitated behaviors are more responsive to treatment than others. ⋯ Patients with higher levels of agitation receiving divalproex had reduced agitation on the physical aggression subscale of the CMAI. Divalproex was less effective on physically nonaggressive behavior and verbal agitation. Irritability, as measured on the NPI-NH, was also reduced. Patients who received both divalproex and an antipsychotic agent were responsive at lower doses of divalproex. In either case, the effective dosage of divalproex was lower than that commonly used for epilepsy or mania in elderly patients. The most common adverse events included somnolence and gait disturbance.
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Am J Geriatr Pharmacother · Sep 2007
Clinical sedation scores as indicators of sedative and analgesic drug exposure in intensive care unit patients.
It is unclear how best to measure sedative/analgesic drug exposure in the clinical care of critically ill patients. Large doses and prolonged use of sedatives and analgesics in the intensive care unit (ICU) may lead to oversedation and adverse effects, including delirium and long-term cognitive impairment. These issues are of particular concern in elderly patients (aged > or =65 years), who account for at least half of all ICU admissions and nearly two thirds of ICU days. ⋯ Elderly patients are commonly encountered in the ICU setting. Only moderate correlations existed between clinical sedation levels and dose or plasma concentration of sedative/analgesic medications in this study population. Further work is needed to understand appropriate and feasible measures of exposure to sedatives/analgesics relating to clinical outcomes.
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Am J Geriatr Pharmacother · Sep 2007
Comparative StudyLow-density lipoprotein cholesterol (LDL-C) levels and LDL-C goal attainment among elderly patients treated with rosuvastatin compared with other statins in routine clinical practice.
Reducing low-density lipoprotein cholesterol (LDL-C) levels lowers the risk of consequences of cardiovascular disease. Research has confirmed these benefits in elderly patients. The 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (ie, statins) have long-standing proven efficacy in reducing levels of LDL-C and total cholesterol. ⋯ In this elderly patient population, rosuvastatin was a more effective treatment for reducing LDL-C levels and attaining NCEP ATP III LDL-C goals than the other statins.
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Am J Geriatr Pharmacother · Sep 2007
Variation in antidiabetic medication intensity among Medicare beneficiaries with diabetes mellitus.
Recent guidelines for treating older patients with diabetes mellitus (DM) and significant disease burden place less emphasis on glycemic control and stress the potential harms that may arise from adherence to strict regimens with antidiabetic medications. However, there are few empirical benchmarks against which clinicians can compare their prescribing practices for patients who have DM and varying levels of comorbidity. ⋯ This national study found that high-cost Medicare beneficiaries with DM received substantially less intensive antidiabetic regimens compared with those incurring more modest medical expenditures in 2002. Longitudinal analysis is necessary to determine whether this finding indicates suboptimal therapy or has a more benign explanation. However, the magnitude of the association warrants the attention of clinicians who treat elderly and disabled diabetic patients with high disease burden.
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Am J Geriatr Pharmacother · Jun 2007
Use of wet nebulized inhaled respiratory medications under criteria-based reimbursement guidelines in a publicly funded Seniors' Pharmacare Program in Nova Scotia, Canada.
During the 1999/2000 fiscal year, approximately 19% of beneficiaries in the Nova Scotia Seniors' Pharmacare Program (NSSPP), a publicly funded drug insurance program in Nova Scotia, Canada, received inhaled respiratory medications by wet nebulization. The cost was estimated at more than Can $2 million annually. On August 1, 2000, the NSSPP initiated new criteria-based reimbursement guidelines for wet nebulized respiratory medications, requiring prior authorization. ⋯ The majority of approved requests for wet nebulization criteria fell within the established reimbursement guidelines. Many approvals outside of guidelines were clinically valid. Approval of requests outside the criteria highlights the need for flexibility in the claims administrative and adjudication system to respond to unique circumstances not covered by established criteria. However, concurrent use of wet nebulization and portable inhalers by some beneficiaries suggests suboptimal use of portable inhalers, the need for portable inhalers for patients using wet nebulization when they leave their residence, and the need for more patient education.