Clinics in geriatric medicine
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Clin. Geriatr. Med. · Aug 2012
Pharmacologic pain management before and after total joint replacement of the hip and knee.
There are many effective treatment measures for OA of the hip or knee, with varying degrees of effectiveness. Nonoperative measures include patient education, physical therapy, activity modification, weight loss, and medications. Pharmacologic strategies include acetaminophen, NSAIDs, injections of cortisone or viscosupplementation, and, less commonly, tramadol or other pain relievers. ⋯ Over the past 20 years, multimodal pain management has been beneficial to the patient undergoing TJR surgery. Studies have shown this form of pain management decreases postoperative opioid consumption and the related adverse effects. Research is warranted in the areas of postoperative pain scores and patient satisfaction as institutional multimodal protocols continue to evolve.
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Clin. Geriatr. Med. · May 2012
Pharmacokinetics and pharmacodynamic changes associated with aging and implications for drug therapy.
The population of older adults continues to increase, and polypharmacy in this population is more the rule than the exception. Physiologic changes that occur with aging result in multiple alterations to the pharmacokinetics and pharmacodynamics of drugs, which, in turn, increase the risk of adverse drug reactions. Consideration of initial dose adjustment, along with frequent medication reconciliation and analysis of the medication list, are keys to providing optimal pharmaceutical care for elderly patients.
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There is a need to improve the quality of end-of-life care in nursing homes by improving the timely assessment and management of various sources of suffering. Much of the research/discussion in this area has focused on the assessment and treatment of pain. This article reviews the frequency and management of nonpain symptoms in the long-term care setting, particularly focusing on patients at the end of life. Although the long-term care setting presents challenges to effective management, an approach for addressing these challenges is discussed and applied to 3 commonly encountered nonpain symptoms.
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Seventy percent of people in the United States who have dementia die in the nursing home. This article addresses the following topics on palliative care for patients with dementia in long-term care: (1) transitions of care, (2) infections, other comorbidities, and decisions on hospitalization, (3) prognostication, (4) the evidence for and against tube feeding, (5) discussing goals of care with families/surrogate decision makers, (6) types of palliative care programs, (7) pain assessment and management, and (8) optimizing function and quality of life for residents with advanced dementia.