The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Jun 2007
Comparative StudyPredictors of long-acting opioid use and oral versus transdermal route among older Medicaid beneficiaries.
The availability of long-acting (LA) opioid medications represents an advance in the treatment of persistent pain, raising the question of what factors predict receipt of this newer treatment approach. ⋯ Demographic and clinical predictors of TDF use differed from predictors of any LA opioid use among these older Medicaid beneficiaries. Qualitative research methods are needed to better understand what factors influence selection of opioid medications for older patients in nursing homes and community settings.
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Am J Geriatr Pharmacother · Jun 2007
Prophylaxis for opioid-induced constipation in elderly long-term care residents: a cross-sectional study of Medicare beneficiaries.
Opioid analgesics are effective therapeutic agents for malignant and nonmalignant pain, but their use is often compromised by unwanted adverse effects on the central nervous system and gastrointestinal (GI) tract. These adverse effects include sedation, respiratory depression, nausea and vomiting, reduction in biliary and pancreatic secretions, decreased GI motility, increased GI transit time, and subsequent constipation. ⋯ Although laxatives are widely recommended in patients taking opioids, only 66% of elderly LTC residents in this study received this standard of care.
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Am J Geriatr Pharmacother · Mar 2007
ReviewStatins for the primary prevention of cardiovascular events in older adults: a review of the evidence.
Although statins have been demonstrated to be beneficial for secondary prevention in the elderly, their use for primary prevention has not been well described. ⋯ Extension of treatment guidelines should consider an individual's global risk of coronary heart disease. However, due to the prevalence of subclinical disease in older adults, risk may be higher or otherwise differ with age. In addition, tolerance for and barriers to adherence with long-term medical therapy are important treatment considerations in older adults. Prospective, randomized controlled trials that better define the tolerability, safety, and efficacy of statin therapy in older adults with elevated cholesterol levels and intermediate cardiovascular risk are needed.
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Am J Geriatr Pharmacother · Mar 2007
Prevalence of vitamin D insufficiency in elderly ambulatory outpatients in Denver, Colorado.
Vitamin D insufficiency is common in the elderly. However, previous studies have utilized 25-hydroxvvitamin D (25[OH]D) concentrations as low as <16 ng/mL for defining vitamin D insufficiency. Moreover, most of the studies have been conducted in European patients, in certain geographic areas of the United States, or in institutionalized elderly. ⋯ Vitamin D insufficiency is prevalent in ambulatory, and especially obese, elderly living in Denver, Colorado, despite vitamin D intake consistent with national recommendations. Dietary intake of vitamin D appeared to be unreliable to prevent insufficiency. Based on our results, along with other published data, we feel that national recommendations for vitamin D intake in the elderly should be increased to at least 800 to 1000 IU/d of over-the-counter supplemental cholecalciferol.
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Am J Geriatr Pharmacother · Mar 2007
Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population?
Studies indicate that adverse drug events (ADEs) are common and costly. It appears that the elderly are at greater risk of ADEs because they use more medications, have less specific presentations, and have more chronic conditions than younger populations. ⋯ In this study population, the number of prescribing physicians was an independent risk factor for patients self-reporting an ADE. More research is needed to confirm and explain this finding. One possibility is poor communication between multiple providers. Physicians should work to ensure more effective coordination of care between providers and communicate information about all medications prescribed to their patients with their colleagues.