Search Our Scientific Publications & Authors

Am J Geriatr Pharmacother 2012 Dec;10(6):381-9

Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, Toronto, Ontario, Canada.

Background: Differences between atypical antipsychotics in their potential to cause parkinsonism and risk factors for antipsychotic-induced parkinsonism are not well established. There is a particular paucity of information on this in real-world use of these drugs, outside of clinical trial settings.

Objective: We compared the incidence of parkinsonism after new treatment with risperidone, olanzapine, or quetiapine in patients with dementia and examined the effects of dose and sex on the risk of parkinsonism. Read More

Am J Geriatr Pharmacother 2012 Dec;10(6):373-80

Centre d'excellence sur le vieillissement de Québec, Centre de recherche FRQ-S du CHU universitaire de Québec, Québec, Canada.

Background: Two cholinesterase inhibitors (ChEIs), rivastigmine and galantamine, are used to treat Alzheimer disease in the Netherlands. Several adverse cardiac events have been reported for these medications.

Objective: We aimed to assess if the use of ChEIs increased the risk of cardiac events in the Netherlands. Read More

Am J Geriatr Pharmacother 2012 Dec;10(6):361-72

Informagenics, LLC, Worthington, OH 43085, USA.

Background: Treatment of venous thromboembolism (VTE) in long-term care (LTC) settings has received little empirical study.

Objective: Among residents with VTE in nursing homes, this analysis evaluated frequency of anticoagulant use, the proportion of residents newly started on warfarin who persisted on therapy (≥3 months), and the association of key resident characteristics, including bleeding risk, with warfarin use and persistence.

Methods: Using the AnalytiCare LTC database (US), eligible residents had deep vein thrombosis or pulmonary embolism coded in the Minimum Data Set (MDS) 2. Read More

Am J Geriatr Pharmacother 2012 Dec 22;10(6):352-60. Epub 2012 Oct 22.

Geriatric Pharmacotherapy Program, Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.

Background: Several classes of drugs, such as antibiotics, may interact with warfarin to cause an increase in warfarins anticoagulant activity and the clinical relevance of warfarin-antibiotic interactions in older adults is not clear.

Objective: The aim of this study was to determine the effect of oral antibiotics, such as amoxicillin, azithromycin, cephalexin, ciprofloxacin, levofloxacin, and moxifloxacin, on the international normalized ratio (INR) in patients ≥65 years on stable warfarin therapy. The secondary objective was to compare the effect of warfarin-antibiotic interactions on outcomes of overanticoagulation. Read More

Am J Geriatr Pharmacother 2012 Dec 17;10(6):343-51. Epub 2012 Oct 17.

GlaxoSmithKline, Research Triangle Park, NC 27709, USA.

Background: National asthma treatment guidelines recommend either the use of inhaled corticosteroids (ICS) or ICS in combination with a long-acting bronchodilator for the treatment of moderate to severe asthma. Even though asthma is common among older adults, few studies have assessed the differences in effectiveness between these two recommended therapies in patients over 65 years of age.

Objective: The aim of this study was to assess the association of the fluticasone-salmeterol combination (FSC) or ICS initiation on asthma-related events in Medicare-eligible asthma patients. Read More

Am J Geriatr Pharmacother 2012 Oct;10(5):323-30

University of Massachusetts Medical School, Worcester, MA 01605, USA.

Background: Little attention has been focused on the safety of medications administered to treat non illnesses in nursing home residents with dementia. It is unclear whether this population is at increased risk of adverse drug events.

Objectives: To test the hypotheses that in nursing home residents with dementia prescribed warfarin have less time in therapeutic range and a higher incidence of nonpreventable and preventable adverse warfarin events compared to nursing home residents without dementia after controlling for facility and patient characteristics. Read More

Am J Geriatr Pharmacother 2012 Oct;10(5):313-22

The Stroke Unit, Sahlgrenska University Hospital, Göteborg, Sweden.

Background: Although treatment with 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.

Objective: The aim was to investigate whether treatment with statins decreases stroke severity and/or improves survival and outcome after stroke in an older population. Read More

Am J Geriatr Pharmacother 2012 Oct;10(5):303-12

College of Pharmacy, The University of Arizona, Tucson, AZ, USA.

Background: Treatment disparities in Alzheimer's disease (AD) have received little attention. Determining whether disparities exist in this subpopulation is an important health policy issue.

Objective: The aim was to determine whether an association existed between race/ethnicity and exposure to AD pharmacotherapy across 4 state Medicaid populations. Read More

Am J Geriatr Pharmacother 2012 Dec 2;10(6):331-42. Epub 2012 Oct 2.

Department of Pharmacy Practice, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA.

Background: Osteoarthritis (OA) is the most common cause of disability in older adults, and although analgesic use can be helpful, it can also result in adverse drug events.

Objective: To review the recent literature to describe potential adverse drug events associated with analgesics commonly used by older adults with OA.

Methods: To identify articles for this review, a systematic search of the English-language literature from January 2001 to June 2012 was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of OA. Read More

Am J Geriatr Pharmacother 2012 Oct 12;10(5):273-83. Epub 2012 Sep 12.

United BioSource Corporation, Lexington, MA, USA.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and disproportionately affects the elderly.

Objective: This study describes patient characteristics and caregiver assistance among Medicare beneficiaries with AF and examines factors associated with receiving anticoagulant treatment.

Methods: Patients with AF and age/gender-matched controls were identified from Medicare Current Beneficiary Survey data from 2001 to 2006. Read More

Am J Geriatr Pharmacother 2012 Oct 1;10(5):284-95. Epub 2012 Sep 1.

New York University College of Nursing, New York, NY 10003, USA.

Background: 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.

Objective: 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. Read More

Am J Geriatr Pharmacother 2012 Oct 22;10(5):296-302. Epub 2012 Aug 22.

Geriatric Research Education and Clinical Center, Central Arkansas Veterans Health Administration System, Little Rock, AR, USA.

Background: Statins are well-known for their cardiovascular benefits. However, the cognitive effects of statins are not well understood. We hypothesized that individuals with preexisting dementia would be more vulnerable to statin-related cognitive effects. Read More

Am J Geriatr Pharmacother 2012 Aug 20;10(4):242-50. Epub 2012 Jul 20.

Department of Pharmacy, Veterans Affairs Western New York Healthcare System, Buffalo, USA.

Background: 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.

Methods: This quasi-experimental study took place from December 2005 to February 2006 at an urban US Veterans Affairs hospital. Read More

Am J Geriatr Pharmacother 2012 Aug 13;10(4):251-7. Epub 2012 Jul 13.

Department of Rehabilitation Medicine, Woodend Hospital, NHS Grampian, Aberdeen, United Kingdom.

Background: 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.

Objective: The purpose of our study was to assess the effect of anticholinergic drug exposure on functional outcomes in older patients undergoing rehabilitation. Read More

Am J Geriatr Pharmacother 2012 Aug 29;10(4):223-9. Epub 2012 Jun 29.

Pharmacy Services, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.

Background: 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 after discharge of elderly patients has not been studied.

Objective: Our aim was to test the convergent, discriminant, and predictive validity of the MRCI in older hospitalized patients with varying functional and cognitive levels. Read More

Am J Geriatr Pharmacother 2012 Aug 9;10(4):230-41. Epub 2012 Jun 9.

VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.

Background: 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.

Objective: 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. Read More

Am J Geriatr Pharmacother 2012 Aug 8;10(4):264-71. Epub 2012 Jun 8.

Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.

Background: 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. Read More

Am J Geriatr Pharmacother 2012 Aug 8;10(4):258-63. Epub 2012 Jun 8.

Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA.

Background: New drugs approved by the Food and Drug Administration (FDA) may offer tremendous clinical advances by providing health care providers with new treatment strategies. However, additional care must be taken for safe and effective use of these new agents by older adults.

Objective: 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. Read More

Am J Geriatr Pharmacother 2012 Jun;10(3):165-77

Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA.

Background: Cognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.

Objective: 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.

Methods: A search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Read More

Am J Geriatr Pharmacother 2012 Jun 12;10(3):211-8. Epub 2012 May 12.

Health Services Research and Development Research Enhancement Award Program, San Francisco VA Medical Center, California, USA.

Background: Clinical practice guidelines have been criticized for insufficient attention to the unique needs of patients of advanced age and with multiple comorbid conditions. However, little empiric research is available to inform this topic.

Methods: We conducted telephone interviews with staff physicians and nurse practitioners in 4 VA health care systems. Read More

Am J Geriatr Pharmacother 2012 Jun 27;10(3):178-84. Epub 2012 Apr 27.

Saint Louis College of Pharmacy, St. Louis, Missouri, USA.

Background: Limited data exist on the use of bisphosphonates in patients with poor kidney function due to a contraindication derived from inadequate experience among patients with kidney failure, accounting for as much as 25% of nonprescribing when otherwise appropriate.

Objectives: To determine whether bisphosphonate use in patients with decreased renal function, as outlined in the package insert (estimated creatinine clearance [eCrCl] <35 mL/min), would result in higher rates of hypocalcemia, as suggested in previous studies.

Methods: This was a retrospective cohort study of elderly veterans 65 years of age and older at the Veterans Affairs North Texas Health Care System in Dallas, Texas. Read More

Am J Geriatr Pharmacother 2012 Jun 24;10(3):185-92. Epub 2012 Apr 24.

Department of Psychiatry, University of Pittsburgh Medical School, Pennsylvania, USA.

Background: Recent studies found use of anticholinergic medications to be associated with greater performance decrements in older persons who carry an ε4 allele of the apolipoprotein E (APOE) gene than in those carrying only ε2 or ε3 alleles.

Objectives: The present study examined whether the apparently greater behavioral toxicity of anticholinergic drugs in ε4 carriers may result from an increased risk of cerebrovascular disease, which is more common in ε4 carriers.

Methods: Cross-sectional data were available from 240 elderly community volunteers who had participated in 2 different studies of the cognitive and motor effects of normal aging. Read More

Am J Geriatr Pharmacother 2012 Jun 21;10(3):201-10. Epub 2012 Apr 21.

Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, USA.

Background: Although maintenance medications are a cornerstone of chronic obstructive pulmonary disease (COPD) management, adherence remains suboptimal. Poor medication adherence is implicated in poor outcomes with other chronic conditions; however, little is understood regarding links between adherence and outcomes in COPD patients.

Objective: This study investigates the association of COPD maintenance medication adherence with hospitalization and health care spending. Read More

Am J Geriatr Pharmacother 2012 Apr;10(2):151-9

School of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Am J Geriatr Pharmacother 2012 Jun 22;10(3):219-22. Epub 2012 Mar 22.

Albany Medical College, Department of Internal Medicine, Division of Geriatric Medicine, Alden March Bioethics Institute, New York, USA.

Background: This case report describes a new adverse drug event due to use of donepezil in a patient with probable Alzheimer's Disease.

Case Summary: 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. Read More

Am J Geriatr Pharmacother 2012 Jun 13;10(3):193-200. Epub 2012 Mar 13.

Department of Geriatrics, Harbour Hospital, Rotterdam, the Netherlands.

Background: Age-dependent changes in lithium pharmacokinetic and pharmacodynamic properties can influence lithium use in an aging population, especially as newer treatment options are available.

Objective: We compared lithium use patterns between middle-aged and elderly outpatients in the Netherlands.

Methods: Data for this study were obtained from the Dutch PHARMO Record Linkage System. Read More

Am J Geriatr Pharmacother 2012 Apr 2;10(2):95-100. Epub 2012 Mar 2.

Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.

Background: The prevalence of prescription medication use increases with age, and older adults are at increased risk of harm from medication use.

Objective: To describe the role of a pharmacist on a General Medicine Acute Care of the Elderly (GM-ACE) Unit.

Methods: A job description was prepared, and a clinical pharmacist specializing in internal medicine was re-assigned to participate in multidisciplinary rounds on the ACE unit twice weekly and to work with a unit-based pharmacist assigned to multiple units. Read More

Am J Geriatr Pharmacother 2012 Apr 3;10(2):123-8. Epub 2012 Mar 3.

Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Background: Elderly persons are exposed to polypharmacy because of multiple chronic conditions. Many risk factors for polypharmacy have been identified including age, race/ethnicity, sex, educational achievement level, health status, and number of chronic diseases. However, drugs prescribed for individual diseases have not been analyzed. Read More

Am J Geriatr Pharmacother 2012 Apr 3;10(2):160-3. Epub 2012 Mar 3.

Jackson Memorial Hospital, Miami, Florida, USA.

Objective: To report clinical challenges in managing dabigatran-induced bleeding.

Methods: A 78-year-old woman came to the hospital with severe coagulopathy, respiratory failure, hypotension, and bleeding secondary to dabigatran therapy. At admission, creatinine clearance was 15 mL/min; prothrombin time, 147. Read More

Am J Geriatr Pharmacother 2012 Feb;10(1):2-13

Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.