The American journal of geriatric pharmacotherapy
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Am J Geriatr Pharmacother · Dec 2006
Multicenter StudyAssociation of age with analgesic use for back and joint disorders in outpatient settings.
Pain is a common, troubling symptom of various disorders, chronically affecting up to 11% of adults in the general public. Despite a growing emphasis on improving the quality of pain management and the increasing use of analgesics over the past 20 years, pain remains undertreated for patients in a variety of clinical settings. Elderly patients, in particular, have disproportionately low rates of adequate pain control compared with younger patients. ⋯ In outpatient settings, elderly patients with pain and back or joint disorders tend to use NSAIDs more often and opioids less often than younger patients, suggesting that older patients may be receiving a poorer quality of pain management in outpatient settings.
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Am J Geriatr Pharmacother · Dec 2006
ReviewRasagiline (TVP-1012): a new selective monoamine oxidase inhibitor for Parkinson's disease.
This article reviews the chemistry, pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability, drug-interaction potential, indications, dosing, and potential role of rasagiline mesylate, a new selective monoamine oxidase (MAO) type B (MAO-B) inhibitor, in the treatment of Parkinson's disease. ⋯ Despite the well-documented selectivity of rasagiline, the manufacturer recommends virtually all of the dietary (vis-à-vis tyramine) and drug restrictions of the nonselective MAO inhibitors. Although useful, selective MAO-B inhibitors have a limited role in Parkinson's disease. Of greater interest is the potential neuroprotective effect of rasagiline and its major metabolite, 1(R)-aminoindan, which may have great utility in a wide variety of neurodegenerative disorders of aging. In addition, bifunctional molecules combining selective MAO-B inhibition (based on the active moiety of rasagiline) with acetylcholinesterase inhibition or iron chelation may eventually be useful in Alzheimer's disease.
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Bipolar affective disorder is not uncommon in the elderly; prevalence rates in the United States range from 0.1% to 0.4%. However, it accounts for 10% to 25% of all geriatric patients with mood disorders and 5% of patients admitted to geropsychiatric inpatient units. These patients often present a tremendous treatment challenge to clinicians. They frequently have differing treatment needs compared with their younger counterparts because of substantial medical comorbidity and age-related variations in response to therapy. Unfortunately, the management of geriatric bipolar disorder has been relatively neglected compared with the younger population. There continues to be a scarcity of published, controlled trials in the elderly, and no treatment algorithms specific to bipolar disorder in the elderly have been devised. ⋯ The data for the treatment of late-life bipolar disorder are limited, but the available evidence shows efficacy for some commonly used treatments. Lithium, divalproex sodium, carbamazepine, lamotrigine, atypical antipsychotics, and antidepressants have all been found to be beneficial in the treatment of elderly patients with bipolar disorder. Although there are no specific guidelines for the treatment of these patients, monotherapy followed by combination therapy of the various classes of drugs may help with the resolution of symptoms. ECT and psychotherapy may be useful in the treatment of refractory disease. There is a need for more controlled studies in this age group before definitive treatment strategies can be enumerated.
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Am J Geriatr Pharmacother · Dec 2006
Multicenter StudyPain and pain medication use in community-dwelling older adults.
Pain is a common symptom and significant problem for older adults; up to one half of community-dwelling older adults have pain that interferes with normal function. ⋯ Prescription pain medication use was associated with pain frequency/severity after adjusting for sociodemographics and OTC pain medications in this study of community-dwelling older adults, suggesting that even with medications, individuals remained in pain.
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Am J Geriatr Pharmacother · Dec 2006
Multicenter StudyThe risk of adverse drug events and hospital-related morbidity and mortality among older adults with potentially inappropriate medication use.
Inappropriate medication prescribing is a significant problem among older adults that may contribute to increased morbidity and mortality as well as increased costs of care. The development of specific lists of medications that are considered potentially inappropriate for older adults, such as the Beers criteria (BC), make it relatively easy to study prescribing practices in large numbers of patients. ⋯ Interventions targeted specifically at BC medications would have seemingly done little to change the risk of ADEs in this population. Interventions that are more comprehensive than the BC are necessary to reduce the risk of ADEs and the associated morbidity and mortality in acute care of the elderly.